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Placental FKBP51 mediates a link between second trimester maternal anxiety and birthweight in female infants. Sci Rep 2018; 8:15151. [PMID: 30310158 PMCID: PMC6181924 DOI: 10.1038/s41598-018-33357-3] [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: 01/03/2018] [Accepted: 06/19/2018] [Indexed: 12/15/2022] Open
Abstract
Prenatal distress is associated with adverse outcomes in affected offspring. Alterations in placental glucocorticoid signalling and subsequent foetal overexposure to glucocorticoids have been implicated as an underlying mechanism. Infant sex is emerging as an important factor in disease susceptibility. This study aimed to examine the effects of maternal distress across pregnancy on birth outcomes and placental glucocorticoid genes in a sex-dependent manner. Participants completed psychological distress questionnaires throughout pregnancy. Placental HSD11B2, NR3C1 and FKBP51 were analysed by real time PCR and cortisol was measured in new-born hair. Second trimester stress was negatively correlated with birthweight in males and positively correlated with placental NR3C1 mRNA in females. Second trimester anxiety was negatively correlated with birthweight and placental FKBP51 mRNA in females. In mediation analysis, placental FKBP51 mRNA expression was found to mediate the link between prenatal anxiety and birthweight. New-born cortisol was negatively correlated with second trimester anxiety and positively correlated with female placental FKBP51 mRNA levels. Again, FKBP51 mRNA was found to mediate the link between anxiety and new-born cortisol. These results highlight a role for FKBP51 in the placental response to prenatal distress in females. The precise role that placental FKBP51 has in foetal and infant development has not been extensively studied and warrants further investigations.
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252
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Bayrampour H, Vinturache A, Hetherington E, Lorenzetti DL, Tough S. Risk factors for antenatal anxiety: A systematic review of the literature. J Reprod Infant Psychol 2018; 36:476-503. [PMID: 30293441 DOI: 10.1080/02646838.2018.1492097] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Given the prevalence of antenatal anxiety and its consistent associations with adverse pregnancy and child outcomes, early detection and management of anxiety are essential. OBJECTIVE The aim was to identify risk factors for anxiety among pregnant women by systematically reviewing original research. METHODS Cross-sectional, case-control and cohort studies that examined associations between antenatal anxiety and at least one potential risk factor prospectively or retrospectively and measured anxiety independent from other mental health conditions were included. Studies rated strong/moderate in methodological quality appraisal were used to synthesise the evidence. RESULTS Factors associated with greater risk of anxiety included previous pregnancy loss, medical complications, childhood abuse, intimate partner violence, denial/acceptance coping styles, personality traits, inadequate social support, history of mental health problems, high perceived stress and adverse life events. CONCLUSIONS Several risk factors identified in this review are detectable in routine prenatal care visits (e.g. previous pregnancy loss, pregnancy complications), potentially modifiable (e.g. coping styles, social support, partner factors) and can be identified prior to pregnancy (e.g. psychosocial factors), underlining the significance of pre-conception mental health screening.
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Affiliation(s)
- Hamideh Bayrampour
- a Department of Family Practice , University of British Columbia , Vancouver , Canada
| | - Angela Vinturache
- b Department of Pediatrics , University of Calgary , Calgary , Canada
| | - Erin Hetherington
- c Department of Community Health Sciences , University of Calgary , Calgary , Canada
| | - Diane L Lorenzetti
- c Department of Community Health Sciences , University of Calgary , Calgary , Canada
| | - Suzanne Tough
- d Departments of Pediatrics and Community Health Sciences , University of Calgary , Calgary , Canada
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253
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Thorsness KR, Watson C, LaRusso EM. Perinatal anxiety: approach to diagnosis and management in the obstetric setting. Am J Obstet Gynecol 2018; 219:326-345. [PMID: 29803818 DOI: 10.1016/j.ajog.2018.05.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/09/2018] [Accepted: 05/16/2018] [Indexed: 11/16/2022]
Abstract
Anxiety is common in women during the perinatal period, manifests with various symptoms and severity, and is associated with significant maternal morbidity and adverse obstetric and neonatal outcomes. Given the intimate relationship and frequency of contact, the obstetric provider is positioned optimally to create a therapeutic alliance and to treat perinatal anxiety. Time constraints, absence of randomized controlled trials, mixed quality of data, and concern for potential adverse reproductive outcomes all limit the clinician's ability to initiate informed risk-benefit discussions. Clear understanding of the role of the obstetric provider in the identification, stabilization, and initiation of medication and/or referral to psychotherapy for women with perinatal anxiety disorders is critical to maternal and neonatal wellbeing. Informed by our clinical practice as perinatal psychiatric providers, we have provided a concise summary of current research on the approach to the treatment of perinatal anxiety disorders in the obstetric setting that includes psychotherapy and supportive interventions, primary and adjuvant psychiatric medication, and general prescribing pearls. Medications that we examined include antidepressants, benzodiazepines, sedative-hypnotics, antihistamines, quetiapine, buspirone, propranolol, and melatonin. Further research into management of perinatal anxiety, particularly psychopharmacologic management, is warranted.
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254
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Khalesi ZB, Bokaie M. The association between pregnancy-specific anxiety and preterm birth: a cohort study. Afr Health Sci 2018; 18:569-575. [PMID: 30602989 PMCID: PMC6306999 DOI: 10.4314/ahs.v18i3.14] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Antenatal anxiety may have long-term negative effects on pregnancy outcome. Antenatal anxiety can also be detrimental to maternal health during pregnancy. Therefore, this study aimed to determine the association between pregnancy-specific anxiety and preterm birth in pregnant women. Methods This prospective cohort study was conducted on 208 pregnant women who were referred to the prenatal clinic of Al-Zahra hospital in Rasht. Sampling was conducted through convenient (simple) method. Data gathering tools were a demographic characteristics questionnaire and pregnancy-specific anxiety scale. The data were analyzed using SPSS version 19. General Linear Model (GLM)-Repeated Measures test were used to study variations in anxiety along pregnancy period and tested levels of significance among inter-trimester anxiety scores. Results Results of the study showed that change in pregnancy-specific anxiety is significantly associated with preterm birth among participants in this study. Second trimester pregnancy-specific anxiety was not associated with preterm birth, but third trimester pregnancy-specific anxiety was associated with preterm birth. Conclusion According to the results of this study, third trimester pregnancy-specific anxiety was associated with preterm birth. Therefore, the health care providers should pay special attention to pregnancy-specific anxiety.
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Affiliation(s)
| | - Mahshid Bokaie
- Research Center for Nursing and Midwifery Care, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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255
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Carroll M, Downes C, Gill A, Monahan M, Nagle U, Madden D, Higgins A. Knowledge, confidence, skills and practices among midwives in the republic of Ireland in relation to perinatal mental health care: The mind mothers study. Midwifery 2018; 64:29-37. [DOI: 10.1016/j.midw.2018.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/15/2018] [Accepted: 05/12/2018] [Indexed: 01/07/2023]
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256
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Conradt E, Adkins DE, Crowell SE, Raby KL, Diamond L, Ellis B. Incorporating epigenetic mechanisms to advance fetal programming theories. Dev Psychopathol 2018; 30:807-824. [PMID: 30068415 PMCID: PMC6079515 DOI: 10.1017/s0954579418000469] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Decades of fetal programming research indicates that we may be able to map the origins of many physical, psychological, and medical variations and morbidities before the birth of the child. While great strides have been made in identifying associations between prenatal insults, such as undernutrition or psychosocial stress, and negative developmental outcomes, far less is known about how adaptive responses to adversity regulate the developing phenotype to match stressful conditions. As the application of epigenetic methods to human behavior has exploded in the last decade, research has begun to shed light on the role of epigenetic mechanisms in explaining how prenatal conditions shape later susceptibilities to mental and physical health problems. In this review, we describe and attempt to integrate two dominant fetal programming models: the cumulative stress model (a disease-focused approach) and the match-mismatch model (an evolutionary-developmental approach). In conjunction with biological sensitivity to context theory, we employ these two models to generate new hypotheses regarding epigenetic mechanisms through which prenatal and postnatal experiences program child stress reactivity and, in turn, promote development of adaptive versus maladaptive phenotypic outcomes. We conclude by outlining priority questions and future directions for the fetal programming field.
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257
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Ravid E, Salzer L, Arnon L, Eisner M, Wiznitzer A, Weller A, Koren L, Hadar E. Is there an association between maternal anxiety propensity and pregnancy outcomes? BMC Pregnancy Childbirth 2018; 18:287. [PMID: 29973180 PMCID: PMC6032557 DOI: 10.1186/s12884-018-1925-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/28/2018] [Indexed: 01/22/2023] Open
Abstract
Background Several studies have shown inconsistent associations between anxiety during pregnancy and adverse pregnancy outcome. This inconsistency may be due to lack of controlling for the timing and type of maternal anxiety. We aimed to isolate a specific type of anxiety - maternal anxiety propensity, which is not directly related to pregnancy, and evaluate its association with adverse pregnancy outcome. Methods We conducted a prospective observational study of 512 pregnant women, followed to delivery. The trait anxiety scale of the State-Trait Anxiety Inventories was used in order to detect a propensity towards anxiety. The association between anxiety propensity (defined as trait-anxiety subscale score above 38) and adverse pregnancy outcome was evaluated. Primary outcome was a composite outcome including preterm birth prior to 37 gestational weeks, hypertensive disorders in pregnancy, small for gestational age newborn and gestational diabetes mellitus. Secondary outcomes were each one of the above mentioned gestational complications. Results There were no significant between-group differences in adverse pregnancy outcomes, including the rate of preterm birth, hypertensive disorders, small for gestational age, gestational diabetes or a composite outcome of them all. Conclusion Anxiety propensity is not associated with adverse pregnancy outcome. Electronic supplementary material The online version of this article (10.1186/s12884-018-1925-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eyal Ravid
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Salzer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Petach-Tikva, Israel
| | - Liat Arnon
- Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Michal Eisner
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Petach-Tikva, Israel
| | - Arnon Wiznitzer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Petach-Tikva, Israel
| | - Aron Weller
- Department of Psychology and the Gonda Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
| | - Lee Koren
- Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Eran Hadar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Petach-Tikva, Israel.
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258
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Lie MLS, Graham RH, Robson SC, Griffiths PD. MRI for Fetal Developmental Brain Abnormalities: Perspectives From the Pregnant Patient. QUALITATIVE HEALTH RESEARCH 2018; 28:1295-1307. [PMID: 29580171 DOI: 10.1177/1049732318764390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Ultrasound is routinely used as a prenatal screening and diagnostic tool but has limitations. Some anomalies in the developing fetal brain can be difficult to detect, and in utero magnetic resonance imaging (iuMRI) is increasingly used as an adjunct to ultrasound. However, understandings of patient perspectives of iuMRI technology are still developing. Our qualitative study of 41 mothers who experienced iuMRI was embedded in a diagnostic accuracy trial and aimed to inform policy recommendations that might stem from the clinical findings. Our analysis suggests that iuMRI is seen as useful, offering valuable additional information and helping women make decisions about care options at a difficult time. However, patients' experiences demonstrated the uncertainty and anxiety associated with the prenatal diagnosis (PND) process relating to brain anomalies including the challenges of their embodied contributions. Our findings suggest more could be done to reduce the impact on pregnant women during an already difficult, anxious period.
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Affiliation(s)
- Mabel L S Lie
- 1 Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ruth H Graham
- 1 Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Paul D Griffiths
- 2 University of Sheffield, Sheffield, United Kingdom
- 3 Royal Hallamshire Hospital, Sheffield, United Kingdom
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259
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Freeman MP, Góez-Mogollón L, McInerney KA, Davies AC, Church TR, Sosinsky AZ, Noe OB, Viguera AC, Cohen LS. Obstetrical and neonatal outcomes after benzodiazepine exposure during pregnancy: Results from a prospective registry of women with psychiatric disorders. Gen Hosp Psychiatry 2018; 53:73-79. [PMID: 29958100 DOI: 10.1016/j.genhosppsych.2018.05.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 04/02/2018] [Accepted: 05/28/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The goal of this analysis was to examine the effect of benzodiazepine use during pregnancy on maternal and neonatal outcomes in a cohort of women with psychiatric disorders. METHODS 794 evaluable women from the Massachusetts General Hospital National Pregnancy Registry for Psychiatric Medications were followed across pregnancy (N = 144 exposed to benzodiazepines and N = 650 unexposed). Data obtained through maternal report and medical records included maternal outcomes (cesarean section, preeclampsia) and neonatal outcomes (birth weight, breathing difficulty, feeding difficulty, head circumference, 5-minute Apgar score, muscular and/or extrapyramidal symptoms, NICU admission, prematurity). RESULTS In adjusted analyses, infants exposed to benzodiazepines in utero were more likely to be admitted to the NICU (OR: 2.02, 95% CI: 1.11, 3.66) and to have small head circumferences (OR: 3.89, 95% CI: 1.25, 12.03) compared to unexposed infants. Other neonatal adverse effects such as respiratory distress or muscular symptoms including hypotonia were not observed. There were no significant differences in adverse obstetrical outcomes. CONCLUSIONS Infants exposed to benzodiazepines during pregnancy had an increased risk of NICU admissions and small head circumferences. Confounding from psychiatric symptoms and other variables cannot be ruled out as contributors to these findings.
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Affiliation(s)
- Marlene P Freeman
- Massachusetts General Hospital, Center for Women's Mental Health, 185 Cambridge St, Boston, MA 02114, United States.
| | - Lina Góez-Mogollón
- Massachusetts General Hospital, Center for Women's Mental Health, 185 Cambridge St, Boston, MA 02114, United States
| | - Kathryn A McInerney
- Massachusetts General Hospital, Center for Women's Mental Health, 185 Cambridge St, Boston, MA 02114, United States; Boston University School of Public Health, Department of Epidemiology, 715 Albany Street, The Talbot Building, T3E & T4E, Boston, MA 02118, United States
| | - Abigail C Davies
- Massachusetts General Hospital, Center for Women's Mental Health, 185 Cambridge St, Boston, MA 02114, United States
| | - Taylor R Church
- Massachusetts General Hospital, Center for Women's Mental Health, 185 Cambridge St, Boston, MA 02114, United States
| | - Alexandra Z Sosinsky
- Massachusetts General Hospital, Center for Women's Mental Health, 185 Cambridge St, Boston, MA 02114, United States
| | - Olivia B Noe
- Massachusetts General Hospital, Center for Women's Mental Health, 185 Cambridge St, Boston, MA 02114, United States
| | - Adele C Viguera
- Massachusetts General Hospital, Center for Women's Mental Health, 185 Cambridge St, Boston, MA 02114, United States; Cleveland Clinic, Cleveland Clinic Neurological Institute, 6770 Mayfield Rd #226, Cleveland, OH 44123, United States
| | - Lee S Cohen
- Massachusetts General Hospital, Center for Women's Mental Health, 185 Cambridge St, Boston, MA 02114, United States
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260
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Fan F, Zou Y, Zhang Y, Ma X, Zhang J, Liu C, Li J, Pei M, Jiang Y, Dart AM. The relationship between maternal anxiety and cortisol during pregnancy and birth weight of chinese neonates. BMC Pregnancy Childbirth 2018; 18:265. [PMID: 29945557 PMCID: PMC6020336 DOI: 10.1186/s12884-018-1798-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/30/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To determine the relationship between maternal anxiety and cortisol values and birth weight at various stages of pregnancy. METHODS Two hundred sixteen pregnant Chinese women were assessed for anxiety and depression and had measurement of morning fasting serum cortisol. Women were assessed either in the first (71), second (72) or third (73) trimester. Birth weights of all children were recorded. RESULTS There were significant negative correlations between anxiety level and birth weight of - 0.507 (p < 0.01) and - 0.275 (p < 0.05) in trimesters 1and 2. In trimester 3 the negative relation between anxiety and birth weight of -.209 failed to reach significance (p = 0.070). There was no relation between depression and birth weight in any trimester (p > 0.5 for all). Maternal cortisol was significantly inversely related to birth weight in trimester 1 (r = - 0.322) and with borderline significance in trimester 2 (r = - 0.229). Anxiety score and maternal cortisol were significantly correlated in each trimester (r = 0.551, 0.650, 0.537). When both anxiety score and maternal cortisol were simultaneously included in multiple regression analyses only anxiety score remained significant. CONCLUSION Whilst both maternal anxiety score and maternal cortisol are inversely related to birth weight the associations with anxiety score were more robust perhaps indicating the importance of mechanisms other than, or in addition to, maternal cortisol in mediating the effects of anxiety. The findings indicate the importance of measures to reduce maternal anxiety, particularly of a severe degree, at all stages of pregnancy. TRIAL REGISTRATION The study was approved by the Ethics Committee of the 1st Affiliated Hospital of Xi'an Jiaotong University.
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Affiliation(s)
- Fenling Fan
- Department of Cardiovascular Medicine, the First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, 710061 China
| | - Yuliang Zou
- Department of Gynaecology and Obstetrics, the First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, 710061 China
| | - Yushun Zhang
- Department of Cardiovascular Medicine, the First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, 710061 China
| | - Xiancang Ma
- Department of Psychology and Psychiatry, the First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, 710061 China
| | - Junbo Zhang
- Department of Cardiovascular Medicine, the First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, 710061 China
| | - Cai Liu
- Department of Gynaecology and Obstetrics, the First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, 710061 China
| | - Jie Li
- Department of Gynaecology and Obstetrics, the First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, 710061 China
| | - Meili Pei
- Department of Gynaecology and Obstetrics, the First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, 710061 China
| | - Yu Jiang
- Department of Gynaecology and Obstetrics, the First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, 710061 China
| | - Anthony M. Dart
- Department of Cardiovascular Medicine, The Alfred, Baker Heart and Diabetes Institute, Melbourne, Vic 3004 Australia
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261
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Hamzehgardeshi Z, Shahhosseini Z, Malari M, Pourasghar M, Yazdani charati J, Amerian M, Amirkhanzadeh Barandouzi Z. Communication skills and anxiety during pregnancy in nulliparous women: A cross-sectional study in an Iranian setting. PREVENTIVE CARE IN NURSING AND MIDWIFERY JOURNAL 2018. [DOI: 10.29252/pcnm.8.1.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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262
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Casey JA, Goldman-Mellor S, Catalano R. Association between Oklahoma earthquakes and anxiety-related Google search episodes. Environ Epidemiol 2018; 2:e016. [PMID: 33210070 PMCID: PMC7660979 DOI: 10.1097/ee9.0000000000000016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/23/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Oklahoma has experienced a rise in seismicity since 2010, with many earthquakes induced by wastewater injection. While large single earthquakes have documented mental health repercussions, health implications of these new, frequent earthquakes remain unknown. We aimed to examine associations between Oklahoma earthquakes and statewide anxiety measured by Google queries. METHODS The U.S. Geologic Survey's Advanced National Seismic System Comprehensive Catalog supplied earthquake dates and magnitudes. We used the Google Health application programming interface to compile the proportion of weekly Oklahoma-based health-related search episodes for anxiety. A quasi-experimental time-series analysis from January 2010 to May 2017 evaluated monthly counts of earthquakes ≥ magnitude 4 (a level felt by most people) in relation to anxiety, controlling for US-wide anxiety search episodes and Oklahoma-specific health-related queries. RESULTS Oklahoma experienced an average of two (SD = 2) earthquakes ≥ magnitude 4 per month during the study period. For each additional earthquake ≥ magnitude 4, the proportion of Google search episodes for anxiety increased by 1.3% (95% confidence interval = 0.1%, 2.4%); 60% of this increase persisted for the following month. In months with 2 or more ≥ magnitude 4 earthquakes, the proportion of Google search episodes focused on anxiety increased by 5.8% (95% confidence interval = 2.3%, 9.3%). In a sub-analysis, Google search episodes for anxiety peaked about 3 weeks after ≥ magnitude 4 quakes. CONCLUSIONS These findings suggest that the recent increase in Oklahoma earthquakes has elicited a psychological response that may have implications for public health and regulatory policy.
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Affiliation(s)
- Joan A. Casey
- School of Public Health, University of California at Berkeley, Berkeley, California
| | - Sidra Goldman-Mellor
- School of Social Sciences, Humanities, and Arts, University of California at Merced, Merced, California
| | - Ralph Catalano
- School of Public Health, University of California at Berkeley, Berkeley, California
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263
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Trujillo J, Vieira MC, Lepsch J, Rebelo F, Poston L, Pasupathy D, Kac G. A systematic review of the associations between maternal nutritional biomarkers and depression and/or anxiety during pregnancy and postpartum. J Affect Disord 2018; 232:185-203. [PMID: 29494902 DOI: 10.1016/j.jad.2018.02.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 02/06/2018] [Accepted: 02/11/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Nutritional requirements need to be met in order to adapt to pre- and postnatal changes. Our aim was to systematically review the evidence of associations between nutritional biomarkers and psychological distress during pregnancy and in the first postnatal year. METHODS MEDLINE, EMBASE, PsycINFO, Scielo, LILACS, clinicaltrials.gov, International Clinical Trials Registry, Cochrane Library, Scopus and Web of Science databases were searched for articles from inception to 4/15/2016. Studies of maternal nutritional biomarkers in blood (fatty acids/micronutrients/amino acids) and associations with psychological distress (depression/anxiety/stress) were included. Two independent reviewers extracted data based on study designs, participants, outcomes, exposures, and association measures. RESULTS Thirty-eight studies were included. A total of 13 studies showed divergent or no associations between serum/plasma/erythrocyte fatty acid concentrations and depression/anxiety during pregnancy and postpartum. Changes in serum cholesterol levels from pregnancy to postpartum showed a significant inverse correlation with depression in one out of three studies. Five out of seven studies found an inverse association between serum vitamin D levels and pre- and postnatal depression. Plasma tryptophan levels were inversely correlated with postnatal depression scores in three out of four studies. We identified that one out of two studies presented no significant association between vitamin B12/folate/ferritin concentrations and depression in postpartum. LIMITATIONS There was higher variability between association measures, time and scales of depression and anxiety assessments. CONCLUSIONS The majority of high-quality studies suggest that lower vitamin D levels may be associated with postpartum depression. However, further evidence is needed for guiding clinical practice on nutritional biomarkers.
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Affiliation(s)
- Janet Trujillo
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Brazil
| | - Matias Costa Vieira
- Division of Women's Health, Women's Health Academic Centre, King's College London, Biomedical Research Centre, King's Health Partners, London, UK
| | - Jaqueline Lepsch
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Brazil
| | - Fernanda Rebelo
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Brazil; Clinical Research Service, National Institute of Cancer, Rio de Janeiro, Brazil
| | - Lucilla Poston
- Division of Women's Health, Women's Health Academic Centre, King's College London, Biomedical Research Centre, King's Health Partners, London, UK
| | - Dharmintra Pasupathy
- Division of Women's Health, Women's Health Academic Centre, King's College London, Biomedical Research Centre, King's Health Partners, London, UK
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Brazil.
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264
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Stevenson EL, Silva S. Multidimensional Psychological Stress During Pregnancies in Women Who Conceived via In Vitro Fertilization. Res Theory Nurs Pract 2018; 31:295-312. [PMID: 28793950 DOI: 10.1891/1541-6577.31.3.295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore relationships among the 3 psychological dimensions of stress, stimulus/environmental, perceptual, and emotional response, and then to develop a multidimensional composite measure of overall stress, and to determine demographic and clinical characteristics associated with stress in women who became pregnant via in vitro fertilization (IVF). METHODS Cross-sectional design using self-report questionnaires during the second trimester. Multidimensional stress was assessed with the Prenatal Life Events Scale, Life Event Distress Scale, Perceived Stress Scale, State-Trait Anxiety Index-State, and the Pregnancy-Related Anxiety Measure. RESULTS Participants (n = 144), aged 25-40 years, were enrolled June 2010-August 2011 from a private fertility clinic. Exploratory principal factor analysis was used to develop an overall stress score from the stress measures. Multiple stepwise regression analyses were conducted to determine characteristics related to the stress measures. White race tended to be associated with lower stress scores (p = .079). White participants also had lower perceived stress (p = .007), and those with a history of miscarriage had higher pregnancy-related anxiety (p = .035). CONCLUSIONS White women had lower perceived stress. History of one or more miscarriage was associated with higher pregnancy-related anxiety. Additional research examining multidimensional stress is needed across the pregnancy trimesters as well as comparisons to women who conceived without IVF both in United States and internationally.
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265
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Vitamin D deficiency and depressive symptoms in pregnancy are associated with adverse perinatal outcomes. J Behav Med 2018; 41:680-689. [DOI: 10.1007/s10865-018-9924-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 04/11/2018] [Indexed: 02/06/2023]
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266
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Akbarian Z, Kohan S, Nasiri H, Ehsanpour S. The Effects of Mental Health Training Program on Stress, Anxiety, and Depression during Pregnancy. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2018; 23:93-97. [PMID: 29628955 PMCID: PMC5881237 DOI: 10.4103/ijnmr.ijnmr_207_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background: The process of becoming a mother is considered as an enjoyable and evolutionary event of women's life. However, due to physical and mental changes, it can be associated with some degree of stress and anxiety that may lead to mental health problems. This study aimed to compare the effects of mental health training during pregnancy on stress, anxiety, and depression between two groups of couples and pregnant women. Materials and Methods: This randomized clinical trial was conducted on 120 pregnant women referring to health centers in Isfahan, Iran, from September to February 2016. The participants were randomly divided into three groups: couples (with the partner present), pregnant women (without the partner present), and control group (routine care). After completing the pretest, the intervention groups received four sessions of pregnancy mental health training. Data were collected using the Depression, Anxiety, and Stress Scales (DASS-42) and a demographic characteristics form. The collected data were analyzed using Statistical Package for the Social Sciences software. Results: Before the intervention, no statistical difference was observed among the three groups in the mean scores of stress, anxiety, and depression. The mean score of depression, anxiety, and stress decreased significantly in the intervention groups 2 weeks after the intervention respectively (F=5.84, p=0.004), (F=14.76, p < 0.001) and (F=11.98, p < 0.001). No significant difference was observed between the couples and pregnant women groups in terms of depression (p = 0.140). Conclusions: The results of this study showed that mental health training for pregnant women, especially with the presence of the partner, is a useful intervention in preventing stress, anxiety, and depression.
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Affiliation(s)
- Zahra Akbarian
- Student Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahnaz Kohan
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Nasiri
- Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Soheila Ehsanpour
- Department of Medical Education, Medical Education Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran
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267
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Giurgescu C, Fahmy L, Slaughter-Acey J, Nowak A, Caldwell C, Misra DP. Can support from the father of the baby buffer the adverse effects of depressive symptoms on risk of preterm birth in Black families? AIMS Public Health 2018; 5:89-98. [PMID: 30083571 PMCID: PMC6070463 DOI: 10.3934/publichealth.2018.1.89] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/16/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND While maternal depressive symptoms during pregnancy have been linked to preterm birth (PTB; birth before 37 completed weeks of gestation), little has been reported on potential buffering factors, particularly specific to Black women who are at much higher risk. We examined the association between depressive symptoms and PTB in pregnant Black women, with father of the baby (FOB) support as a potential buffering factor. METHODS Data were obtained from the life-course influences on fetal environments study (2009-2011), a cohort of 1,410 Black women in metropolitan Detroit, Michigan (71% response rate) using maternal interviews and medical record abstraction collected during the postpartum hospitalization. The 20-item Center for Epidemiologic Studies Depression (CES-D) scale was used to measure depressive symptoms. The 14-item social networks in adult relations questionnaire was used to assess the mother's relationship with the FOB. Logistic regression was used to explore the interaction between CES-D and FOB support with regard to PTB risk. We adjusted for maternal advanced age, income, education level, smoking status, hypertension, prenatal care and BMI. RESULTS The PTB rate in this cohort was 17.7%. Among women with FOB scale < 60 (less support), the odd ratio (OR) of PTB for women with CES-D scores ≥ 23 (severe depressive symptoms) as compared to CES-D scores < 23 (no severe depressive symptoms) was 2.57 [95% confidence interval (CI): 1.68, 3.94; p < 0.001]. Among women with FOB scores ≥ 60 (more support), the odds of PTB in women with CES-D scores ≥ 23 did not significantly differ from the odds of PTB in women with CES-D scores < 23 (OR = 1.34; 95% CI: 0.74, 2.44; p = 0.3). After adjustment for covariates, among women with FOB scores < 60, the OR of PTB for women with CES-D scores ≥ 23 compared to < 23 was 2.79 (95% CI: 1.75, 4.45; p < 0.001). Among women with FOB scores ≥ 60, the odds of PTB in women with CES-D scores ≥ 23 was not statistically significantly different compared to the odds of PTB in women with CES-D scores < 23 (OR = 1.21; 95% CI: 0.62, 2.35; p = 0.6). The interaction term was statistically significant (p = 0.04). DISCUSSION/CONCLUSIONS The adverse effect of depressive symptoms on risk of PTB may be buffered by factors such as a supportive relationship with the FOB.
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Affiliation(s)
| | - Lara Fahmy
- Department of Family Medicine & Public Health Sciences, School of Medicine, Wayne State University, Detroit
| | | | | | - Cleopatra Caldwell
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor
| | - Dawn P Misra
- Department of Family Medicine & Public Health Sciences, School of Medicine, Wayne State University, Detroit
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268
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Dewell S, Slater D, Benzies K, McDonald S, Tough S. Relationship Between Psychosocial Distress in Pregnancy and Two Genes Associated With Human Social Interaction: A Pilot Study. SAGE Open Nurs 2018; 4:2377960818765272. [PMID: 33415193 PMCID: PMC7774440 DOI: 10.1177/2377960818765272] [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: 10/18/2017] [Revised: 02/02/2018] [Accepted: 02/18/2018] [Indexed: 11/17/2022] Open
Abstract
Background Prenatal depression, anxiety, and stress (prenatal psychosocial distress) are common, and several environmental risk factors have been implicated in their development. Variation in genes, specifically single nucleotide polymorphisms (SNPs), may explain why some women develop maternal mental health concerns while others do not. Purpose The purpose of this pilot study was to determine the feasibility of completing SNP analyses using whole blood collected prenatally between 2008 and 2011. We examined the association between SNPs in two genes (FKBP5 and OXTR) among women with low and high prenatal psychosocial distress. Methods A subset (N = 50, 25 high and 25 low prenatal psychosocial distress) of participants was selected from the All Our Families pregnancy cohort. DNA was extracted from maternal blood and used for selected SNP analysis. Participants’ scores on the Edinburgh Prenatal Depression Scale, Spielberger State Anxiety Inventory, and Perceived Stress Scale were used along with demographic variables. Results Genotype distribution was not significantly different between the low and high prenatal psychosocial distress groups for either the FKBP5 or the OXTR SNP (p = .699 and p = .125). After controlling for maternal age and income, women with the GG genotype at the OXTR SNP (rs237885) were statistically less likely to be in the high prenatal psychosocial distress group (p = .037). Conclusion OXTR SNP rs237885, maternal age, and lower income were associated with prenatal psychosocial distress. This pilot study demonstrated the feasibility of continuing to a larger study that incorporates additional environmental and genetic information.
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Affiliation(s)
- Sarah Dewell
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Donna Slater
- Departments of Physiology & Pharmacology and Obstetrics & Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.,Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sheila McDonald
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Suzanne Tough
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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269
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Higgins A, Downes C, Monahan M, Gill A, Lamb SA, Carroll M. Barriers to midwives and nurses addressing mental health issues with women during the perinatal period: The Mind Mothers study. J Clin Nurs 2018; 27:1872-1883. [PMID: 29314366 DOI: 10.1111/jocn.14252] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2017] [Indexed: 01/12/2023]
Abstract
AIMS AND OBJECTIVES To explore barriers to midwives and nurses addressing mental health issues with women during the perinatal period. BACKGROUND Perinatal mental health is considered an important public health issue with health policy internationally identifying the importance of psychological support for women in the perinatal period. Midwives and primary care nurses are ideally positioned to detect mental distress early, but evidence suggests that they are reluctant to discuss mental health issues with women during pregnancy or in the postnatal period. DESIGN The research used a descriptive design. METHODS A total of 809 midwives and nurses completed an anonymous, online or hard copy survey. Designed by the research team, the survey listed 26 potential barriers to the provision of perinatal mental health care. RESULTS Participants identified organisational factors as presenting the greatest barriers. Organisational barriers included lack of perinatal mental health services, absence of care pathways, heavy workload, lack of time, lack of privacy and not seeing women regularly enough to build a relationship. Over 50% of participants identified practitioner-related barriers, such as lack of knowledge on perinatal mental health and cultural issues; lack of skill, in particular, skills to respond to a disclosure of a mental health issue; and fears of causing women offence and distress. Findings also indicated that the context of care and education influenced the degree to which participants perceived certain items as barriers. CONCLUSIONS Midwives and primary care nurses encounter many organisational- and practitioner-related barriers that negatively impact on their ability to incorporate mental health care into their practice. RELEVANCE TO CLINICAL PRACTICE Midwifery and nursing services need to develop strategies to address system- and practitioner-related barriers, including the development of services and care pathways, and the provision of culturally sensitive education on perinatal mental health in order to support practitioners to address issues with confidence and competence.
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Affiliation(s)
- Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Carmel Downes
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Mark Monahan
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Ailish Gill
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Stephen A Lamb
- Waterford/Wexford Mental Health Services HSE South, Waterford, Ireland
| | - Margaret Carroll
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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270
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Abstract
Since the inception of prenatal care in the early 1900s, the focus of care has been on risk reduction rather than on health promotion. Prenatal care began as individualized care, but more recently group prenatal care has been shown to be very successful in improving birth outcomes. For all women, an emphasis on improving health behaviors is important at this critical time while women are engaging regularly with the healthcare system. An emphasis on mental health promotion may decrease some of the disparities in birth outcomes that are well documented between minority and majority women, as minority women are known to experience increased levels of stress, anxiety, and depression. Providing support for pregnant women and incorporating knowledge and skills through prenatal care may promote both physical and mental health in minority women.
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271
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Alqahtani AH, Al Khedair K, Al-Jeheiman R, Al-Turki HA, Al Qahtani NH. Anxiety and depression during pregnancy in women attending clinics in a University Hospital in Eastern province of Saudi Arabia: prevalence and associated factors. Int J Womens Health 2018; 10:101-108. [PMID: 29503587 PMCID: PMC5826248 DOI: 10.2147/ijwh.s153273] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background Anxiety and depression during the antenatal period is a growing problem with major effects on the mother, the developing fetus, and the neonate. Objectives To assess the prevalence of anxiety and depression during pregnancy in women attending the hospital for antenatal care and assess the associated factors. Methods This is a prospective cohort study conducted in the University Hospital of Imam Abdulrahman Bin Faisal University. Anxiety was evaluated using State Trait Anxiety Inventory. Depression was assessed using Edinburgh Postnatal Depression Scale (EPDS). Results Complete data were available for 575 women. The mean EPDS score was 10.5 (SD 5.5). The prevalence of depression was 26.8%. The mean state-anxiety score was 38.4 (SD 11.4) and mean trait-anxiety score was 38.2 (SD 9.5). The prevalence of anxiety using state-anxiety scale was 23.6%, while using the trait scale it was 23.9%. The risk is higher among unemployed women with history of miscarriage and unplanned pregnancy. Conclusion Anxiety and depression are common during pregnancy.
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Affiliation(s)
- Abdullah H Alqahtani
- Department of Psychiatry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam
| | - Kholoud Al Khedair
- Department of Obstetrics and Gynaecology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Reem Al-Jeheiman
- Department of Obstetrics and Gynaecology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Haifa A Al-Turki
- Department of Obstetrics and Gynaecology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nourah H Al Qahtani
- Department of Obstetrics and Gynaecology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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272
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Identifying evidence-practice gaps and strategies for improvement in Aboriginal and Torres Strait Islander maternal health care. PLoS One 2018; 13:e0192262. [PMID: 29415024 PMCID: PMC5802899 DOI: 10.1371/journal.pone.0192262] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 01/11/2018] [Indexed: 01/21/2023] Open
Abstract
Introduction Adverse pregnancy outcomes are more common among Aboriginal and Torres Strait Islander populations than non-Indigenous populations in Australia. Later in life, most of the difference in life expectancy between Aboriginal and Torres Strait Islander women and non-Indigenous women is due to non-communicable diseases (NCDs). Most Aboriginal and Torres Strait Islander women attend health services regularly during pregnancy. Providing high-quality care within these appointments has an important role to play in improving the current and future health of women and babies. Aim This study engaged stakeholders in a theory-informed process to use aggregated continuous quality improvement (CQI) data to identify 1) priority evidence-practice gaps in Aboriginal and Torres Strait Islander maternal health care, 2) barriers and enablers to high-quality care, and 3) strategies to address identified priorities. Methods Three phases of reporting and feedback were implemented using de-identified CQI data from 91 health services between 2007 and 2014 (4,402 client records). Stakeholders (n = 172) from a range of professions and organisations participated. Results Stakeholders identified four priority areas relating to NCDs: smoking, alcohol, psychosocial wellbeing and nutrition. Barriers or enablers to high-quality care included workforce support, professional development, teamwork, woman-centred care, decision support, equipment and community engagement. Strategies to address the priorities included upskilling staff to provide best practice care in priority areas, advocating for availability of healthy food, housing and local referral options, partnering with communities on health promotion projects, systems to facilitate continuity of care and clear referral pathways. Conclusions This novel use of large-scale aggregate CQI data facilitated stakeholder input on priority evidence-practice gaps in maternal health care in Australia. Evidence-practice gaps relating to NCD risk factors and social determinants of health were prioritised, and stakeholders suggested both healthcare-focussed initiatives and approaches involving the community and the wider health sector. The findings can inform health service planning, advocacy, inter-agency strategies, and future research.
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273
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Doktorchik C, Premji S, Slater D, Williamson T, Tough S, Patten S. Patterns of change in anxiety and depression during pregnancy predict preterm birth. J Affect Disord 2018; 227:71-78. [PMID: 29053978 DOI: 10.1016/j.jad.2017.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 08/28/2017] [Accepted: 10/01/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND To determine whether changes in anxiety and depression during pregnancy influence the risk of having a preterm birth (PTB), and whether chronic stress modifies this relationship. METHODS The data source for the current study is the All Our Babies prospective cohort (AOB). Anxiety and depression were measured at 17-24 weeks and again at 32-36 weeks' gestation using the Spielberg State Anxiety Scale and the Edinburgh Postnatal Depression Scale, respectively. Chronic stress was assessed at 17-24 weeks' gestation as a potential covariate, and was measured using the Perceived Stress Scale. Multivariable logistic regression modeling was used to assess each relationship RESULTS: Women who experienced an increase in anxiety scores, (time point 32-36 weeks, compared to the earlier time point 17-24 weeks), had 2.70 times higher odds of preterm delivery, compared to those with a reduction in anxiety scores (95% CI 1.28, 5.69). Consistent low or high depression scores did not significantly influence the odds of PTB compared to a decrease in depression scores. A co-occurring increase in anxiety and depression scores was not found to increase the risk of PTB, and chronic stress did not modify any of these relationships. LIMITATIONS This study was limited by a relatively small sample of women who delivered preterm, and therefore it was not possible to conduct additional analyses. Further, the analyses were limited to mostly late preterm infants (32-36 weeks' gestation). CONCLUSIONS These findings should be validated with additional cohorts and a larger sample size. Ultimately, primary prevention could address anxiety during pregnancy.
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Affiliation(s)
- Chelsea Doktorchik
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6.
| | - Shahirose Premji
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6; Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Room 293 Heritage Medical Research Building, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1.
| | - Donna Slater
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Room 293 Heritage Medical Research Building, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1; Departments of Physiology & Pharmacology and Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1.
| | - Tyler Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Room 293 Heritage Medical Research Building, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6.
| | - Suzanne Tough
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Room 293 Heritage Medical Research Building, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1; Department of Pediatrics, Cumming School of Medicine, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB, Canada T3B 6A8.
| | - Scott Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6; Department of Psychiatry, Cumming School of Medicine, University of Calgary, 1403 29th Street NW, Calgary, AB, Canada T2N 2T9.
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274
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Redinger S, Norris SA, Pearson RM, Richter L, Rochat T. First trimester antenatal depression and anxiety: prevalence and associated factors in an urban population in Soweto, South Africa. J Dev Orig Health Dis 2018; 9:30-40. [PMID: 28877770 DOI: 10.1017/s204017441700071x] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Depression and anxiety in the antenatal period are of public health concern given potential adverse effects for both mother and infant. Both are under-researched in the first trimester of pregnancy, especially in Africa. We examine the prevalence of first trimester antenatal depression and anxiety in a cohort of South African women and investigate associated risk factors. Data were collected from 946 women (2014-2016) in the Soweto First 1000 Days Cohort, a prospective pregnancy cohort in Soweto, South Africa. Antenatal depression was assessed using the Edinburgh Postnatal Depression Scale with a score of ⩾13 indicating probable depression. Anxiety was assessed using the short form of the State-Trait Anxiety Index with a score ⩾12 indicating probable anxiety. Prevalence of antenatal depression was 27% [95% confidence interval (CI) 24.2-29.8] and anxiety 15.2% (95% CI 12.9-17.5). Factors associated with antenatal depression and anxiety were predominantly relationship- and family-centred. Women who perceived that their partner made life harder for them had three-fold increased odds for depression [(odds ratio (OR) 3.33 [2.28-4.85] P<0.001], whereas those with family stressors had almost double the odds for depression (OR 1.78 [1.22-2.59] P=0.003) and anxiety (OR 1.75 [1.44-2.69] P=0.0011). Antenatal depression and anxiety are common in the first trimester of pregnancy, and partner and family relationship stressors are central. Longitudinal analysis is needed to determine if this is a phase of adjustment to pregnancy or onset of persistent symptomology. Early intervention may have secondary preventative effects and should involve the partner and family.
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Affiliation(s)
- S Redinger
- 1MRC/Developmental Pathways to Health Research Unit,School of Clinical Medicine, Faculty of Health Sciences,University of the Witwatersrand,Johannesburg,South Africa
| | - S A Norris
- 1MRC/Developmental Pathways to Health Research Unit,School of Clinical Medicine, Faculty of Health Sciences,University of the Witwatersrand,Johannesburg,South Africa
| | - R M Pearson
- 5School of Social and Community Medicine,Centre for Academic Mental Health,Bristol University,Bristol,UK
| | - L Richter
- 2DST-NRF Centre of Excellence in Human Development,University of Witwatersrand,Johannesburg,South Africa
| | - T Rochat
- 1MRC/Developmental Pathways to Health Research Unit,School of Clinical Medicine, Faculty of Health Sciences,University of the Witwatersrand,Johannesburg,South Africa
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275
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Downes C, Carroll M, Gill A, Monahan M, Higgins A. Practice nurses' knowledge and competence in relation to perinatal mental health care. ACTA ACUST UNITED AC 2017. [DOI: 10.12968/pnur.2017.28.12.542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Carmel Downes
- University of Dublin Trinity College, Dublin, Ireland
| | | | - Ailish Gill
- University of Dublin Trinity College, Dublin, Ireland
| | - Mark Monahan
- University of Dublin Trinity College, Dublin, Ireland
| | - Agnes Higgins
- University of Dublin Trinity College, Dublin, Ireland
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276
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Depression, anxiety, PTSD and comorbidity in perinatal women in Turkey: A longitudinal population-based study. Midwifery 2017; 55:29-37. [DOI: 10.1016/j.midw.2017.09.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 09/01/2017] [Accepted: 09/01/2017] [Indexed: 11/19/2022]
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277
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Hunter A, Tussis L, MacBeth A. The presence of anxiety, depression and stress in women and their partners during pregnancies following perinatal loss: A meta-analysis. J Affect Disord 2017; 223:153-164. [PMID: 28755623 DOI: 10.1016/j.jad.2017.07.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/15/2017] [Accepted: 07/05/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Research indicates perinatal loss is associated with anxiety, depression and stress in women and partners during subsequent pregnancies. However, there are no robust estimates of anxiety, depression and stress for this group. We meta-analytically estimated rates of anxiety, depression and stress in pregnant women and their partners during pregnancies after previous perinatal loss. METHODS Databases (Medline, PsychInfo, Embase, Cinahl Plus) and grey literature were searched from 1995 through to May 2016. Search terms included: depression, anxiety, or stress with perinatal loss (miscarry*, perinatal death, spontaneous abortion, fetal death, stillbirth, intrauterine death, TOPFA) and subsequent pregnancy. Case-controlled, English-language studies using validated measures of anxiety, depression or stress in women or partners during pregnancy following perinatal loss were included. Data for effect sizes, study and demographic data were extracted. RESULTS We identified nineteen studies representing n = 5114 women with previous loss; n = 30,272 controls; n = 106 partners with previous perinatal loss; and n = 91 control men. Random effects modelling demonstrated significant effects of perinatal loss on anxiety (d = 0.69, 95% CI = 0.41-0.97) and depression (d = 0.22, 95% CI = 0.15-0.30) in women; but no effect on stress (d = - 0.002, 95% CI = - 0.0639 to 0.0605). LIMITATIONS This study was limited by the quality of available studies, underpowered moderator analyses and an inability to examine additional covariates. Insufficient data were available to generate reliable effects for psychological distress in partners. CONCLUSIONS Our findings confirm elevated anxiety and depression levels during pregnancies following perinatal loss. Further research on predictors of distress in women and their partners is required.
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Affiliation(s)
- Amanda Hunter
- Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - Lorena Tussis
- Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - Angus MacBeth
- Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland, UK.
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278
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Yamamoto S, Premji S. The Role of Body, Mind, and Environment in Preterm Birth: Mind the Gap. J Midwifery Womens Health 2017; 62:696-705. [PMID: 29135075 DOI: 10.1111/jmwh.12658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 06/26/2017] [Accepted: 06/29/2017] [Indexed: 12/20/2022]
Abstract
Preterm birth continues to be a problem affecting low-, middle-, and high-income countries, with rates increasing in some areas despite ongoing efforts to reduce the incidence. This emphasizes the need for more effective interventions, particularly if we aim to achieve the broad health targets of the Sustainable Development Goals (SDGs) by 2030. The current focus on medically-oriented interventions such as reducing nonmedically-indicated induction of labor, cesarean birth, and multiple embryo transfers associated with assisted reproductive technologies, as well as the application of cervical cerclage and use of progesterone therapy, though important, are likely only partial solutions to the complex phenomenon of preterm birth. Preterm birth has multiple etiologies. The biologic mechanisms involved in preterm labor and how it may be triggered are not well understood. There is growing evidence to suggest some of these triggers may also be related to stress and environmental conditions. In this review, we focus on evidence concerning psychosocial (mind) and environmental factors (environment) as well as briefly review the evidence related to maternal and fetal factors (body) associated with the risk of preterm birth, with reference to some of the SDGs. We also assess emerging evidence regarding the interaction of the body, mind, and environment in relation to preterm birth, currently a gap in our knowledge, and how these interactions could impact clinical practice. Findings suggest that multidisciplinary expertise and approaches will be needed to develop effective interventions to address the complex etiologies of preterm birth, as opposed to single-risk-factor mitigation. Clinicians and researchers will play key roles in identifying many of these risk factors and shaping interventions that address this complex issue. Addressing the interlinkages between body, mind, and environment through the integration of research and clinical practice is critical to reducing the risk of preterm birth and contributing to the achievement of the SDGs.
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Vujović M, Sovilj M, Jeličić L, Stokić M, Plećaš D, Plešinac S, Nedeljković N. Correlation between maternal anxiety, reactivity of fetal cerebral circulation to auditory stimulation, and birth outcome in normotensive and gestational hypertensive women. Dev Psychobiol 2017; 60:15-29. [PMID: 29091282 DOI: 10.1002/dev.21589] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/10/2017] [Indexed: 12/17/2022]
Abstract
This study investigated the correlation between maternal anxiety and blood flow changes through the fetal middle cerebral artery (MCA) after defined acoustic stimulation in 43 normotensive (C) and 40 gestational hypertensive (GH) subjects. Neonatal outcomes (gestational age at birth, Apgar score, birth weight) in the C and GH groups were analyzed. State (STAI-S) and trait (STAI-T) anxiety was assessed using Spielberger's questionnaire. The MCA blood flow was assessed once between 28 and 41 weeks of gestation using color Doppler ultrasound before and after application of defined acoustic stimulus. Relative size of the Pulsatility index (Pi) change (RePi) was calculated. The general hypotheses were: (1) women in GH group would have higher anxiety; (2) higher anxiety correlates with higher RePi change and poorer neonatal outcome; (3) fetuses from the GH group would have poorer neonatal outcome. Subjects from the GH group had higher STAI-T and RePi compared to the C group. A positive correlation between RePi and STAI-S, STAI-T, and systolic/diastolic blood pressure was found in both groups. There were more preterm deliveries in the GH group compared to the C group. A significant effect of STAI-T on body weight was observed in the C and GH group. There was a predictive effect of STAI-T and RePi on the C group, and STAI-S, STAI-T, diastolic blood pressure, and RePi on the GH group in terms of neonatal body weight. This study demonstrates an association between antenatal anxiety in GH women and increased fetal cerebral circulation in response to defined auditory stimulation.
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Affiliation(s)
- Marina Vujović
- Institute for Experimental Phonetics and Speech Pathology, Belgrade, Serbia
| | - Mirjana Sovilj
- Institute for Experimental Phonetics and Speech Pathology, Belgrade, Serbia.,Life Activities Advancement Center, Belgrade, Serbia
| | - Ljiljana Jeličić
- Institute for Experimental Phonetics and Speech Pathology, Belgrade, Serbia.,Life Activities Advancement Center, Belgrade, Serbia
| | - Miodrag Stokić
- Institute for Experimental Phonetics and Speech Pathology, Belgrade, Serbia.,Life Activities Advancement Center, Belgrade, Serbia
| | - Darko Plećaš
- Clinical Center of Serbia, Medical Faculty, University Clinic for Obstetrics and Gynecology, University of Belgrade, Belgrade, Serbia
| | - Snežana Plešinac
- Clinical Center of Serbia, Medical Faculty, University Clinic for Obstetrics and Gynecology, University of Belgrade, Belgrade, Serbia
| | - Nadežda Nedeljković
- Faculty of Biology, Department for General Physiology and Biophysics, University of Belgrade, Belgrade, Serbia
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280
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Evans K, Morrell CJ, Spiby H. Systematic review and meta-analysis of non-pharmacological interventions to reduce the symptoms of mild to moderate anxiety in pregnant women. J Adv Nurs 2017; 74:289-309. [PMID: 28921612 DOI: 10.1111/jan.13456] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2017] [Indexed: 11/27/2022]
Abstract
AIM To assess the effectiveness of non-pharmacological interventions for pregnant women with symptoms of mild to moderate anxiety. BACKGROUND Many pregnant women experience mild to moderate symptoms of anxiety and could benefit from additional support. Non-pharmacological interventions have been suggested for use during pregnancy. DESIGN A systematic review of randomized controlled trials. DATA SOURCES Randomized controlled trials published since 1990, identified from electronic databases: Medline; CINAHL; Maternity and Infant Care; PsycINFO; Cochrane Database of Systematic Reviews; CENTRAL; EMBASE; Centre for Reviews and Dissemination; Social Sciences Citation Index; ASSIA; HTA Library; Joanna Briggs Institute Evidence-Based Practice database; Allied and Complementary Medicine. REVIEW METHODS Conducted according to the Centre for Reviews and Dissemination procedure. Papers were screened (N = 5,222), assessed for eligibility (N = 57) and selected for inclusion (N = 25). The Cochrane Collaboration's tool for assessing risk of bias was used. Papers were assessed for clinical and statistical heterogeneity and considered for meta-analysis. Descriptive analysis of the data was conducted. RESULTS Psychological, mind-body, educational and supportive interventions were delivered individually and to groups of pregnant women over single or multiple sessions. The State-Trait Anxiety Inventory was the most commonly used anxiety measure. In 60% of studies there were fewer than 40 participants. Meta-analysis of three studies indicated no observed beneficial effect in the reduction of anxiety. CONCLUSION There was insufficient evidence from which to draw overall conclusions regarding the benefit of interventions. Results were predominantly based on small samples. Many papers provided an inadequate description of methods which prevented a full assessment of methodological quality.
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Affiliation(s)
- Kerry Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - C Jane Morrell
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Helen Spiby
- School of Health Sciences, University of Nottingham, Nottingham, UK.,School of Nursing and Midwifery, University of Queensland, Brisbane, Australia
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281
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van den Bosch M, Ode Sang Å. Urban natural environments as nature-based solutions for improved public health - A systematic review of reviews. ENVIRONMENTAL RESEARCH 2017; 158:373-384. [PMID: 28686952 DOI: 10.1016/j.envres.2017.05.040] [Citation(s) in RCA: 268] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 05/02/2017] [Accepted: 05/22/2017] [Indexed: 05/18/2023]
Abstract
Increasing urbanisation, changing disease scenarios, and current predictions of climate change impacts require innovative strategies for providing healthy and sustainable cities, now and in the future. The recently coined concept, Nature-based solutions (NBS), is one such strategy referring to actions that are inspired by, supported by, or copied from nature, designed to address a range of environmental challenges. The objective with this article is to evaluate the evidence on public health benefits of exposure to natural environments and explore how this knowledge could be framed within the NBS concept. We conducted a systematic review of reviews following established methodology, including keyword search in several databases, predefined inclusion criteria, and a data extraction in accordance with the PICOS structure. We reviewed literature on associations between public health and natural environments in relation to pathways - sociobehavioural/cultural ecosystem services (e.g. stress and physical activity) and regulating ecosystem services (e.g. heat reduction) - or defined health outcomes (e.g. cardiovascular mortality). The results show that there is strong evidence for improved affect as well as on heat reduction from urban natural environments. These conditions may mediate the effect seen on cardiovascular disease (CVD)-related mortality by exposure to natural environments. By also reviewing existing literature on NBS and health, we phrase the results within the NBS context, providing guidelines on how public health and well-being could be integrated into implementation of NBS for resilient and liveable urban landscapes and health in a changing climate.
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Affiliation(s)
- M van den Bosch
- School of Population and Public Health, The University of British Columbia, Canada; Department of Forest and Conservation Sciences, The University of British Columbia, Canada
| | - Å Ode Sang
- Dept. of Landscape Architecture, Planning and Management, Swedish University of Agricultural Sciences, Sweden.
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282
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The Latina Birth Weight Paradox: the Role of Subjective Social Status. J Racial Ethn Health Disparities 2017; 5:747-757. [DOI: 10.1007/s40615-017-0419-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/27/2017] [Accepted: 07/17/2017] [Indexed: 01/08/2023]
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283
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Psychological morbidity and parenting stress in mothers of primary school children by timing of acquisition of HIV infection: a longitudinal cohort study in rural South Africa. J Dev Orig Health Dis 2017; 9:41-57. [PMID: 28899439 DOI: 10.1017/s204017441700068x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Longitudinal maternal mental health data are needed from high HIV prevalence settings. The Siyakhula Cohort (SC) is a population-based cohort of HIV-positive and negative mothers (n=1506) with HIV-negative children (n=1536) from rural South Africa. SC includes 767 HIV-negative mothers; 465 HIV-positive in pregnancy; 272 HIV-positive since pregnancy (n=2 missing HIV status). A subgroup (n=890) participated in a non-randomized breastfeeding intervention [Vertical Transmission Study (VTS)]; the remaining (n=616) were resident in the same area and received antenatal care at the time of the VTS, but were not part of the VTS, instead receiving the standard of care Prevention of Mother-to-Child Transmission (PMTCT) Programme. In secondary analysis we investigated the prevalence of, and factors associated with, psychological morbidity amongst mothers who were still the primary caregiver of the child (1265 out of 1506) at follow-up (7-11 years post-birth). We measured maternal depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder Scale-7) and parenting stress (Parenting Stress Index-36), using standardized cut-offs and algorithms. In total, 75 (5.9%) mothers met criteria for depression, 37 (2.9%) anxiety and 134 (10.6%) parenting stress. Using complete case logistic regression (n=1206 out of 1265 mothers) as compared to being HIV-negative, testing HIV-positive in pregnancy doubled odds of depression [adjusted odd ratios (aOR)=1.96 [1.0-3.7] P=0.039]. Parenting stress was positively associated with acquisition of HIV after pregnancy (aOR=3.11 [1.9-5.2] P<0.001) and exposure to household crime (aOR=2.02 [1.3-3.2] P=0.003); negatively associated with higher maternal education (aOR=0.29 [0.1-0.8] P=0.014), maternal employment (aOR=0.55 [0.3-0.9] P=0.024). Compared with the standard of care PMTCT, VTS mothers had reduced odds of parenting stress (aOR=0.61 [0.4-0.9] P=0.016). Integrating parental support into mostly bio-medical treatment programmes, during and beyond pregnancy, is important.
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284
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García-Blanco A, Diago V, Serrano De La Cruz V, Hervás D, Cháfer-Pericás C, Vento M. Can stress biomarkers predict preterm birth in women with threatened preterm labor? Psychoneuroendocrinology 2017; 83:19-24. [PMID: 28558282 DOI: 10.1016/j.psyneuen.2017.05.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/22/2017] [Accepted: 05/22/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Preterm birth is a major paediatric challenge difficult to prevent and with major adverse outcomes. Prenatal stress plays an important role on preterm birth; however, there are few stress-related models to predict preterm birth in women with Threatened Preterm Labor (TPL). OBJECTIVE The aim of this work is to study the influence of stress biomarkers on time until birth in TPL women. METHODS Eligible participants were pregnant women between 24 and 31 gestational weeks admitted to the hospital with TPL diagnosis (n=166). Stress-related biomarkers (α-amylase and cortisol) were determined in saliva samples after TPL diagnosis. Participants were followed-up until labor. A parametric survival model was constructed based on α-amylase, cortisol), TPL gestational week, age, parity, and multiple pregnancy. The model was adjusted using a logistic distribution and it was implemented as a nomogram to predict the labor probability at 7- and 14-day term. RESULTS The time until labor was associated with cortisol (p=0.001), gestational week at TPL diagnosis (p=0.004), and age (p=0.02). Importantly, high cortisol levels at TPL diagnosis were predictive of latency to labor. Validation of the model yielded an optimum corrected AUC value of 0.63. CONCLUSIONS High cortisol levels at TPL diagnosis may have an important role in the preterm birth prediction. Our statistical model implemented as a nomogram provided accurate predictions of individual prognosis of pregnant women.
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Affiliation(s)
- Ana García-Blanco
- Neonatal Research Unit, Health Research Institute La Fe, Valencia, Spain; University of Valencia, Valencia, Spain.
| | - Vicente Diago
- Division of Obstetrics and Gynecology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - David Hervás
- Biostatistics Unit, Health Research Institute La Fe, Valencia, Spain
| | | | - Máximo Vento
- Neonatal Research Unit, Health Research Institute La Fe, Valencia, Spain
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285
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Togher KL, Treacy E, O'Keeffe GW, Kenny LC. Maternal distress in late pregnancy alters obstetric outcomes and the expression of genes important for placental glucocorticoid signalling. Psychiatry Res 2017; 255:17-26. [PMID: 28511050 DOI: 10.1016/j.psychres.2017.05.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 03/13/2017] [Accepted: 05/07/2017] [Indexed: 12/18/2022]
Abstract
The experience of maternal distress in pregnancy is often linked with poorer obstetric outcomes for women as well as adverse outcomes for offspring. Alterations in placental glucocorticoid signalling and subsequent increased fetal exposure to cortisol have been suggested to underlie this relationship. In the current study, 121 pregnant women completed the Perceived Stress Scale, State Trait Anxiety Inventory and Edinburgh Postnatal Depression Scale in the third trimester of pregnancy. Placental samples were collected after delivery. Maternal history of psychiatric illness and miscarriage were significant predictors of poorer mental health in pregnancy. Higher anxiety was associated with an increase in women delivering via elective Caesarean Section, and an increase in bottle-feeding. Birth temperature was mildly reduced among infants of women with high levels of depressive symptomology. Babies of mothers who scored high in all stress (cumulative distress) measures had reduced 5-min Apgar scores. High cumulative distress reduced the expression of placental HSD11B2 mRNA and increased the expression of placental NR3C1 mRNA. These data support a role for prenatal distress as a risk factor for altered obstetric outcomes. The alterations in placental gene expression support a role for altered placental glucocorticoid signalling in the relationship between maternal prenatal distress and adverse outcomes.
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Affiliation(s)
- Katie L Togher
- Irish Centre for Fetal and Neonatal Translation Research (INFANT), Cork University Maternity Hospital, University College Cork, Cork, Ireland; Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Cork, Ireland; Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Eimear Treacy
- Irish Centre for Fetal and Neonatal Translation Research (INFANT), Cork University Maternity Hospital, University College Cork, Cork, Ireland; Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Cork, Ireland; Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Gerard W O'Keeffe
- Irish Centre for Fetal and Neonatal Translation Research (INFANT), Cork University Maternity Hospital, University College Cork, Cork, Ireland; Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland.
| | - Louise C Kenny
- Irish Centre for Fetal and Neonatal Translation Research (INFANT), Cork University Maternity Hospital, University College Cork, Cork, Ireland; Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Cork, Ireland.
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286
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It Is Time for Routine Screening for Perinatal Mood and Anxiety Disorders in Obstetrics and Gynecology Settings. Obstet Gynecol Surv 2017; 72:553-568. [DOI: 10.1097/ogx.0000000000000477] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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287
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Silva MMDJ, Nogueira DA, Clapis MJ, Leite EPRC. Anxiety in pregnancy: prevalence and associated factors. Rev Esc Enferm USP 2017; 51:e03253. [PMID: 28902327 DOI: 10.1590/s1980-220x2016048003253] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/25/2017] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Evaluating the occurrence of anxiety in pregnant women and the factors associated with its occurrence; comparing the presence of anxiety in each gestational trimester. METHOD A descriptive, correlational cross-sectional study. Data were collected from January to May 2013 using the Hospital Anxiety Subscale and a form composed of socioeconomic characterization; gestational anamnesis; life-changing habits and events; preexisting conditions and interpersonal relationships. RESULTS A total of 209 pregnant women from a municipality in the south of Minas Gerais, Brazil, participated in the study. Anxiety was present in 26.8% of the pregnant women, being more frequent in the third trimester (42.9%). Occupation (p=0.04), complications in previous pregnancies (p=0.00), history of miscarriage risk of preterm birth (p=0.05), maternal desire regarding the pregnancy (p=0.01), number of abortions (p=0.02), number of cigarettes smoked daily (p=0.00) and drug use (p=0.01) were statistically associated with the occurrence of anxiety during pregnancy. CONCLUSION Anxiety occurred frequently during pregnancy. Understanding the factors associated with its occurrence allows for elaborating preventive measures in prenatal care. OBJETIVO Avaliar a ocorrência da ansiedade em gestantes e os fatores associados à sua ocorrência; comparar a presença de ansiedade em cada trimestre gestacional. MÉTODO Estudo descritivo, correlacional, de corte transversal. A coleta de dados ocorreu de janeiro a maio de 2013, utilizou-se da Subescala Hospitalar de Ansiedade e de um formulário composto por caracterização socioeconômica; anamnese gestacional; hábitos e eventos marcantes de vida; patologias preexistentes e relacionamentos interpessoais. RESULTADOS Participaram do estudo 209 gestantes de um município do sul de Minas Gerais. A ansiedade esteve presente em 26,8% das gestantes, sendo mais frequente no terceiro trimestre (42,9%). Ocupação (p=0,04), complicações em gestações anteriores (p=0,00), histórico de abortamento/ameaça de parto prematuro (p=0,05), desejo materno em relação à gravidez (p=0,01), número de abortamentos (p=0,02), quantidade de cigarros consumidos diariamente (p=0,00) e uso de drogas (p=0,01) apresentaram associação estatisticamente significativa com a ocorrência da ansiedade na gravidez. CONCLUSÃO A ansiedade se mostrou frequente na gestação. O conhecimento dos fatores associados a sua ocorrência oportuniza a elaboração de medidas preventivas na assistência pré-natal.
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Affiliation(s)
- Mônica Maria de Jesus Silva
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Programa de Enfermagem em Saúde Pública, Ribeirão Preto, SP, Brazil
| | | | - Maria José Clapis
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto, SP, Brazil
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288
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Grigoriadis S, Peer M. The Perinatal Treatment Conundrum. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:514-516. [PMID: 28777922 PMCID: PMC5546671 DOI: 10.1177/0706743717717693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sophie Grigoriadis
- 1 Department of Psychiatry, Women's Mood and Anxiety Clinic: Reproductive Transitions, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Miki Peer
- 2 Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario
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289
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Weis KL, Lederman RP, Walker KC, Chan W. Mentors Offering Maternal Support Reduces Prenatal, Pregnancy-Specific Anxiety in a Sample of Military Women. J Obstet Gynecol Neonatal Nurs 2017; 46:669-685. [PMID: 28751158 DOI: 10.1016/j.jogn.2017.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the efficacy of the Mentors Offering Maternal Support (MOMS) program to reduce pregnancy-specific anxiety and depression and build self-esteem and resilience in military women. DESIGN Randomized controlled trial with repeated measures. SETTING Large military community in Texas. PARTICIPANTS Pregnant women (N = 246) in a military sample defined as active duty or spouse of military personnel. METHODS Participants were randomized in the first trimester to the MOMS program or normal prenatal care. Participants attended eight 1-hour sessions every other week during the first, second, and third trimesters of pregnancy. Pregnancy-specific anxiety, depression, self-esteem, and resilience were measured in each trimester. Linear mixed models were used to compare the two-group difference in slope for prenatal anxiety, depression, self-esteem, and resilience. RESULTS The Prenatal Self-Evaluation Questionnaire was used to measure perinatal anxiety. Rates of prenatal anxiety on the Identification With a Motherhood Role (p = .049) scale and the Preparation for Labor (p = .017) scale were significantly reduced for participants in MOMS. Nulliparous participants showed significantly lower anxiety on the Acceptance of Pregnancy scale and significantly greater anxiety on the Preparation for Labor scale. Single participants had significantly greater anxiety on the Well-Being of Self and Baby in Labor scale, and participants with deployed husbands had significantly greater anxiety on the Identification With a Motherhood Role scale. CONCLUSION Participation in the MOMS program reduced pregnancy-specific prenatal anxiety for the dimensions of Identification With a Motherhood Role and Preparation for Labor. Both dimensions of anxiety were previously found to be significantly associated with preterm birth and low birth weight. Military leaders have recognized the urgent need to support military families.
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290
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Abstract
Perinatal mental health has important implications for maternal and child outcomes. Most women with psychiatric disorders during pregnancy go undiagnosed and untreated, despite widespread initiatives for early identification. Universal screening for psychiatric disorders, particularly depression and anxiety, has been implemented in obstetric and primary care settings. However, there is little evidence regarding the effectiveness on psychiatric symptom reduction or prevention of adverse outcomes in children. Recently, comprehensive screening and follow-up programs integrated within obstetric or primary care settings have shown promising results in improving maternal mental health outcomes. Further work is needed to determine best clinical and most cost-effective practices.
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Affiliation(s)
- Shannon N Lenze
- Department of Psychiatry, Washington University School of Medicine, Campus Box 8504, 660 South Euclid Avenue, St Louis, MO 63110, USA.
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291
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Broberg L, Backhausen M, Damm P, Bech P, Tabor A, Hegaard HK. Effect of supervised exercise in groups on psychological well-being among pregnant women at risk of depression (the EWE Study): study protocol for a randomized controlled trial. Trials 2017; 18:210. [PMID: 28476136 PMCID: PMC5420113 DOI: 10.1186/s13063-017-1938-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 04/11/2017] [Indexed: 11/20/2022] Open
Abstract
Background Pregnant women with depression and/or anxiety prior to pregnancy are at higher risk of preterm birth, breastfeeding problems, postpartum depression, and disruption of the mother-infant attachment. It is well documented that exercise improves psychological well-being in nonpregnant subjects with symptoms of depression. However, in only a few small studies have researchers examined the effect of exercise on symptoms of depression among pregnant women. We hypothesize that physiotherapist-supervised group exercise for pregnant women at risk of antenatal depression increases their psychological well-being. This paper describes the study protocol of a randomized controlled trial (RCT) on a supervised group exercise intervention for pregnant women with a current or previous history of depression and/or anxiety. Methods/design The RCT is being carried out at the Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, in the period 2016–2019. The inclusion criteria are pregnant women ≥18 years of age with depression and/or anxiety requiring treatment by a psychiatrist or a psychologist within the last 10 years and/or intake of antidepressants in the 3 months prior to conception and/or during pregnancy. The women must have appropriate Danish language skills, be pregnant with a single fetus, give written informed consent, and be at 17–22 gestational weeks when the intervention begins. The primary outcome is psychological well-being (the five-item World Health Organization Well-being Index). Secondary outcomes are symptoms of depression (Edinburgh Postnatal Depression Scale), functional ability (General Health Questionnaire), clinical symptoms of anxiety (State-Trait Anxiety Inventory), sleep quality and sleep disturbances (Pittsburgh Sleep Quality Index), and pregnancy and delivery outcomes. The intervention is supervised group exercise twice weekly for 12 weeks. The control group will receive standard antenatal care. On the basis of sample size calculation, a total of 300 women will be randomly assigned to either the intervention or the control group in a ratio of 1:1. Discussion The trial is expected to contribute to the body of knowledge used in planning antenatal care for pregnant women at risk of depression. Trial registration ClinicalTrials.gov, NCT02833519. Registered on 19 May 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1938-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lotte Broberg
- Research Unit Women's and Children's Health, Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. .,Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Mette Backhausen
- Research Unit Women's and Children's Health, Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Peter Damm
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Bech
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Ann Tabor
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hanne Kristine Hegaard
- Research Unit Women's and Children's Health, Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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292
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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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293
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Yang S, Yang R, Liang S, Wang J, Weaver NL, Hu K, Hu R, Trevathan E, Huang Z, Zhang Y, Yin T, Chang JJ, Zhao J, Shen L, Dong G, Zheng T, Xu S, Qian Z, Zhang B. Symptoms of anxiety and depression during pregnancy and their association with low birth weight in Chinese women: a nested case control study. Arch Womens Ment Health 2017; 20:283-290. [PMID: 28013409 DOI: 10.1007/s00737-016-0697-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/22/2016] [Indexed: 11/29/2022]
Abstract
This study is a nested case control study from a population-based cohort study conducted in Wuhan, China. The aim is to estimate the association between symptoms of depression during pregnancy (DDP), anxiety during pregnancy(ADP), and depression with anxiety during pregnancy (DADP) and low birth weight (LBW) and to examine the extent to which preterm birth (PTB) moderates these associations. Logistic regression analyses were used to model associations between DDP, ADP, and DADP and LBW. Models were stratified by the presence or absence of PTB to examine moderating effects. From the cohort study, 2853 had a LBW baby (cases); 5457 pregnant women served as controls. Women with DDP or ADP only were not at higher risk of having a LBW baby, but DADP was associated with increased risk of LBW (crude OR 1.41, 95% CI 1.17-1.70; adjusted OR 1.29, 95% CI 1.07-1.57), and the significant association was particularly evident between DADP and LBW in PTB, but not in full-term births. Our data suggests that DADP is related to an increased risk of LBW and that this association is most present in PTBs.
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Affiliation(s)
- Shaoping Yang
- Wuhan Medical and Health Center for Women and Children, 100 Hongkong Road, Wuhan, Hubei, 430015, China
| | - Rong Yang
- Wuhan Medical and Health Center for Women and Children, 100 Hongkong Road, Wuhan, Hubei, 430015, China
| | - Shengwen Liang
- Wuhan Environmental Monitoring Center, 422 Xinhua Road, Wuhan, Hubei, China, 430015
| | - Jing Wang
- College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
| | - Nancy L Weaver
- College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
| | - Ke Hu
- Wuhan Environmental Monitoring Center, 422 Xinhua Road, Wuhan, Hubei, China, 430015
| | - Ronghua Hu
- Wuhan Medical and Health Center for Women and Children, 100 Hongkong Road, Wuhan, Hubei, 430015, China
| | - Edwin Trevathan
- College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
| | - Zhen Huang
- Wuhan Environmental Monitoring Center, 422 Xinhua Road, Wuhan, Hubei, China, 430015
| | - Yiming Zhang
- Wuhan Medical and Health Center for Women and Children, 100 Hongkong Road, Wuhan, Hubei, 430015, China
| | - Ting Yin
- Wuhan Environmental Monitoring Center, 422 Xinhua Road, Wuhan, Hubei, China, 430015
| | - Jen Jen Chang
- College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
| | - Jinzhu Zhao
- Wuhan Medical and Health Center for Women and Children, 100 Hongkong Road, Wuhan, Hubei, 430015, China
| | - Longjiao Shen
- Wuhan Environmental Monitoring Center, 422 Xinhua Road, Wuhan, Hubei, China, 430015
| | - Guanghui Dong
- School of Public Health, Sun Yat-Sen University, 135 Xingang Xi Road, Guangzhou, 510080, China
| | - Tongzhang Zheng
- School of Public Health, Brown University, Providence, RI, 02912, USA
| | - Shunqing Xu
- Tongji Medical College, Huazhong University of Science and Technology, 13 Hang Kong Road, Wuhan, Hubei, 430030, China
| | - Zhengmin Qian
- College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA.
| | - Bin Zhang
- Wuhan Medical and Health Center for Women and Children, 100 Hongkong Road, Wuhan, Hubei, 430015, China.
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294
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[Mental disorders in pregnancy and postpartum : Prevalence, course, and clinical diagnostics]. DER NERVENARZT 2017; 87:926-36. [PMID: 27456195 DOI: 10.1007/s00115-016-0175-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The peripartum period represents a critical phase for the onset and course of mental disorders. During this phase, mental disorders occur as first onset or, more often, as recurrent or ongoing chronic conditions with onset and further course of illness in- or outside the peripartal period. No clear risk increase exists for the more prevalent mental disorders such as depressive and anxiety disorders during this period, whereas there is an increased risk for bipolar disorder. Peripartal mental disorders may impact fetal and child development through different mechanisms. The International Statistical Classification of Diseases and Related Health Problems (ICD-10) does not sufficiently take into account particularities of peripartal disorders with possible prognostic relevance. The present article gives an overview on prevalence, course, and clinical diagnostics and presents a proposal for consistent categorization of peripartal mental disorders.
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295
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Lecompte V, Richard-Fortier Z, Rousseau C. Adverse effect of high migration stress on mental health during pregnancy: a case report. Arch Womens Ment Health 2017; 20:233-235. [PMID: 27696006 DOI: 10.1007/s00737-016-0671-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022]
Abstract
Despite empirical evidence on the numerous consequences associated with high migration stress and mental health problems during pregnancy, a psychosocial stress assessment is rarely done, leaving it largely unaddressed. This case illustration sheds light on the common multiple risk factors related to migration stress that have to be taken into consideration when addressing perinatal mental health, and highlights the importance of obstetric appointments as a unique opportunity to assess psychosocial stress and mobilize interdisciplinary interventions.
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Affiliation(s)
| | | | - Cécile Rousseau
- Department of Psychiatry, McGill University, Montréal, Canada
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296
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Jonsdottir SS, Thome M, Steingrimsdottir T, Lydsdottir LB, Sigurdsson JF, Olafsdottir H, Swahnberg K. Partner relationship, social support and perinatal distress among pregnant Icelandic women. Women Birth 2017; 30:e46-e55. [DOI: 10.1016/j.wombi.2016.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/09/2016] [Accepted: 08/10/2016] [Indexed: 11/25/2022]
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297
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‘Stress, anger, fear and injustice’: An international qualitative survey of women's experiences planning a vaginal breech birth. Midwifery 2017; 44:41-47. [DOI: 10.1016/j.midw.2016.11.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 10/09/2016] [Accepted: 11/20/2016] [Indexed: 11/24/2022]
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298
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Huizink A, Menting B, De Moor M, Verhage ML, Kunseler F, Schuengel C, Oosterman M. From prenatal anxiety to parenting stress: a longitudinal study. Arch Womens Ment Health 2017; 20. [PMID: 28634716 PMCID: PMC5599437 DOI: 10.1007/s00737-017-0746-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this study was to explore how maternal mood during pregnancy, i.e., general anxiety, pregnancy-specific anxiety, and depression predicted parenting stress 3 months after giving birth, thereby shaping the child's early postnatal environmental circumstances. To this end, data were used from 1073 women participating in the Dutch longitudinal cohort Generations2, which studies first-time pregnant mothers during pregnancy and across the transition to parenthood. Women filled out the State Trait Anxiety Inventory (STAI), Pregnancy-Related Anxiety Questionnaire-revised (PRAQ-R), and Beck Depression Index (BDI) three times during pregnancy: at 12, 22, and 32 weeks gestational age. Three months postpartum, a parenting stress questionnaire was filled out yielding seven different parenting constructs. Latent scores were computed for each of the repeatedly measured maternal mood variables with Mplus and parenting stress constructs were simultaneously regressed on these latent scores. Results showed that trait anxiety and pregnancy-specific anxiety were uniquely related to almost all parenting stress constructs, taking depression into account. Early prevention and intervention to reduce maternal anxiety in pregnancy could hold the key for a more advantageous trajectory of early postnatal parenting.
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Affiliation(s)
- A.C. Huizink
- Department of Clinical Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands ,Section of Clinical Child and Family Studies, Department of Educational and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
| | - B. Menting
- Department of Clinical Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands ,EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands ,Netherlands Institute for the Study of Crime and Law Enforcement (NSCR), Amsterdam, The Netherlands
| | - M.H.M. De Moor
- Section of Clinical Child and Family Studies, Department of Educational and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
| | - M. L. Verhage
- Section of Clinical Child and Family Studies, Department of Educational and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
| | - F.C. Kunseler
- Section of Clinical Child and Family Studies, Department of Educational and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
| | - C. Schuengel
- Section of Clinical Child and Family Studies, Department of Educational and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
| | - M. Oosterman
- Section of Clinical Child and Family Studies, Department of Educational and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
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299
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Neisani Samani L, Chehreh H, Seyed Fatemi N, Hosseini F, Karamelahi Z. Relationship between Perceived Social Support and Anxiety in Pregnant Women Conceived through Assisted Reproductive Technologies (ARTs). ACTA ACUST UNITED AC 2016. [DOI: 10.29252/ijn.29.103.51] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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300
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Evans K, Morrell CJ, Spiby H. Women's views on anxiety in pregnancy and the use of anxiety instruments: a qualitative study. J Reprod Infant Psychol 2016. [PMID: 29517294 DOI: 10.1080/02646838.2016.1245413] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To explore women's experience of anxiety in pregnancy and views on the use of anxiety instruments in antenatal care. BACKGROUND Anxiety in pregnancy is associated with adverse birth outcomes, developmental and behavioural problems in infants and postnatal depression. Despite recommendations for routine psychological assessment in pregnancy, the optimal methods to identify anxiety in pregnancy have not been confirmed. METHODS A qualitative study using two focus group discussions was undertaken. Focus group one included women in a community setting and focus group two included women in a hospital clinic setting who had received additional support for anxiety in pregnancy. Participants were women who had given birth within the past nine months and considered themselves to have been anxious during their pregnancy. RESULTS Three main themes were identified using template analysis: sources of support, administration of anxiety instruments and the use of instruments to prompt discussion. Women stated that anxiety instruments could help them to identify their anxious feelings and prompt a discussion around those feelings. However, they expressed concerns surrounding the administration of anxiety instruments and questioned how useful they would be in helping women access help and support. CONCLUSIONS The introduction of anxiety instruments in antenatal care may present an opportunity to discuss women's emotional health and anxieties. Providing women with sufficient time to discuss their anxious feelings, identified by such instruments, could facilitate access to additional support.
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Affiliation(s)
- Kerry Evans
- a Nottingham University Hospitals NHS Trust UK , Nottingham , UK
| | - C Jane Morrell
- b Health Research, School of Health Sciences , University of Nottingham, Queen's Medical Centre , Nottingham , UK
| | - Helen Spiby
- c Midwifery, School of Health Sciences , University of Nottingham , Nottingham , UK.,d School of Nursing & Midwifery , University of Queensland , Brisbane , Australia
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