Dyadic Intervention during Pregnancy? Treating Pregnant Women and Possibly Reaching the Future Baby

"Which baby?": a qualitative study exploring the fantasies about the unborn baby among women with hyperemesis gravidarum

This study aims to explore the conscious fantasies about the unborn baby among women experiencing hyperemesis gravidarum and identify possible clinical implications. Fourteen inpatient women with moderate to severe symptoms of hyperemesis gravidarum and between the 12 and 14 weeks gestation participated in semi-structured interviews. Analysis of the transcripts revealed escape and aggression fantasies about the baby, denial of fantasies in the categories tested (name, sex, external and internal characteristics of the baby), freezing of the maternal-fetus bond, and ambivalence toward the continuation of the pregnancy. Neither the severity of symptoms nor the stated quality of life mediated the results. These findings suggest that the discussion and reframing of fantasies can be proven helpful and relieving for the women facing any pregnancy complication. Toward achieving a multidisciplinary approach, the variable of fantasy should be considered among others.

Non-physiological and Physiological Delivery Method: Comparison of Maternal Attachment Behaviors and Anxiety

Introduction: Attachment is a stable connection or emotional knot between two individuals as one of the parties tries to maintain this connection. Delivery time as a turning point between two stages of attachment is very important. Methods: In a descriptive-analytical study based on specific inclusion criteria, 262 pregnant women were selected in the age range of 15-45 years old and the gestational age of 37 to 42 weeks who were candidates for physiological or non-physiological delivery. After obtaining written consent forms, the demographic information questionnaire was given to the participants. One hour after delivery, the attachment questionnaire was completed by the researcher in the postpartum ward. Also, the Spielberg anxiety inventory was completed up to 1 hour after delivery. Independent sample t test was used to compare the results between the two groups. Data were analyzed by SPSS software version 21. Results: The participants in the physiological delivery group showed more positive attachment behaviors in comparison with the other group. In all three dimensions of attachment (emotional, contiguous, and caring behavior), physiological delivery showed higher scores than the other group. Also in non-physiological delivery group, the participants had experienced higher levels of anxiety and the differences between the groups were not significant. Conclusion: Results of the current study indicated that mothers engaged in physiological delivery had higher scores in mother to child attachment behaviors. It means they are more successful than the non-physiological delivery group in getting attached to their babies.

Maternal depressive symptomatology during pregnancy is a risk factor affecting newborn's health: a longitudinal study

Background: Depression symptomatology in pregnant women is a condition that represents an important risk factor for the health of both women and children. Objectives: The aim of this study was to investigate the influence of women's depression symptomatology on the clinical aspects of their delivery, both directly and indirectly, through mothers' prenatal attachment to their unborn children. Moreover, we analysed whether these aspects affect the well-being of the newborn, assessed through the Apgar score. Methods: A longitudinal design was carried out on a total of 203 pregnant women. At weeks 31-32 of gestation, women filled out the Beck Depression Inventory and the Prenatal Attachment Inventory. The day of childbirth, hospital healthcare staff registered the clinical data of childbirth. Results: A woman's depressive symptomatology negatively affects prenatal attachment to her unborn child and positively affects the clinical aspects of the delivery, both directly and mediated by the quality of prenatal attachment. Moreover, the Apgar score was negatively influenced by the clinical aspects of the delivery and, indirectly, by the depressive symptomatology. Conclusion: Depressive symptomatology during pregnancy has negative outcomes, affecting the delivery experience of women, the first emotional bond with the child, and the well-being of the newborn.

Interventions to treat mental disorders during pregnancy: A systematic review and multiple treatment meta-analysis

BACKGROUND

For women suffering from an antepartum mental disorder (AMD), there is lack of evidence-based treatment algorithms due to the complicated risk-benefit analysis for both mother and unborn child. We aimed to provide a comprehensive overview of pharmacological and non-pharmacological interventions to treat AMD and performed a meta-analysis of the estimated treatment effect on the psychiatric symptoms during pregnancy.

METHODS

MedLine, PsycINFO and Embase databases were searched by two independent reviewers for clinical trials with a control condition on treatment of women with AMD, i.e. major depressive (MDD), anxiety, psychotic, eating, somatoform and personality disorders. We inventoried the effect of the treatment, i.e. decrease of psychiatric symptoms at the end of the treatment or postpartum. We adhered to the PRISMA-protocol.

FINDINGS

Twenty-nine trials were found involving 2779 patients. Trials studied patients with depressive disorders (k = 28), and anxiety disorders (k = 1). No pharmacological trials were detected. A form of psychotherapy, like Cognitive Behavioural Therapy (g = -0.61; 95%CI:-0.73 to -0.49, I2 = 0%; k = 7) or Interpersonal Psychotherapy (g = -0.67; 95%CI:-1.27 to -0.07; I2 = 79%; k = 4), holds robust benefit for pregnant women with MDD. Body-oriented interventions (g = -0.43; 95%CI:-0.61 to -0.25; I2 = 17%; k = 7) and acupuncture (g = -0.43; 95%CI:-0.80 to -0.06; I2 = 0%; k = 2) showed medium sized reduction of depressive symptoms. Bright light therapy (g = -0.59; 95%CI:-1.25 to 0.06; I2 = 0%; k = 2), and food supplements (g = -0.51; 95%CI:-1.02 to 0.01; I2 = 20%; k = 3) did not show significant treatment effects. One study was found on Integrative Collaborative Care.

CONCLUSIONS

This meta-analysis found a robust moderate treatment effect of CBT for MDD during pregnancy, and to a lesser extent for IPT. As an alternative, positive results were found for body-oriented interventions and acupuncture. No evidence was found for bright light therapy and food supplements. Only non-pharmacological trials on women with MDD were found. Research on a wider range of AMD is needed.