1
|
Wu HN, Liang Y, Li LL, Jiang HY, Xu LL. The safety of benzodiazepines and related drugs during pregnancy: an updated meta-analysis of cohort studies. Arch Gynecol Obstet 2024; 310:45-54. [PMID: 38806942 DOI: 10.1007/s00404-024-07557-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/14/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE The prevalence of benzodiazepines and related drugs (BZRDs) use during pregnancy increased sharply in recent years. Thus, there are concerns regarding the pregnancy outcomes following exposure to BZRDs. METHODS Two electronic databases were thoroughly searched to identify related clinical studies published from inception until June 2023. English-language cohort studies with high-quality comparing antenatal BZRDs exposure to an unexposed group on any delivery outcome were included. RESULTS Ten cohort studies that estimated adverse neonatal outcomes associated with exposure to BZRDs during pregnancy were included. Exposure to BZRDs during pregnancy was associated with an increased risk of congenital malformation [odds ratio (OR) 1.09, 95% confidence interval (CI) 1.05-1.13, p < 0.001], heart malformation (OR 1.13, 95% CI 1.04-1.22, p = 0.003), preterm birth (OR 1.45, 95% CI 1.23-1.7, p < 0.001), SGA (OR 1.18, 95% CI 1.08-1.29, P < 0.001), LBW (OR 1.42, 95% CI 1.25-1.6, p = 0.001) or low Apgar score (OR 1.42, 95% CI 1.08-1.87, p = 0.011),compared with no exposure. Further analyses limited to the first trimester exposure yielded consistent results. CONCLUSIONS Exposure to BZRDs during pregnancy may be associated with several adverse neonatal outcomes. However, we could not rule out the potential indication confounding factor, further studies with high-quality that control for important confounders are still needed to verify our findings.
Collapse
Affiliation(s)
- Huai-Neng Wu
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310013, Zhejiang, China
| | - Yan Liang
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310013, Zhejiang, China
| | - Ling-Li Li
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310013, Zhejiang, China
| | - Hai-Yin Jiang
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lian-Lian Xu
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310013, Zhejiang, China.
| |
Collapse
|
2
|
Thela L, Paruk S, Bhengu B, Chiliza B. Psychiatric emergencies during pregnancy and puerperium in low - And middle-income countries. Best Pract Res Clin Obstet Gynaecol 2024; 94:102478. [PMID: 38401484 DOI: 10.1016/j.bpobgyn.2024.102478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/26/2024]
Abstract
Pregnancy and puerperium are critical points in women's health, and various psychiatric emergencies may worsen or manifest (for the first time) during this period. In the presence of a psychiatric emergency, the pregnancy and puerperium outcomes may be compromised. In addition to the mother being at risk, the health of the fetus and the newborn may also be compromised if the psychiatric emergency is not managed appropriately. Early detection and collaborative approaches between mental health practitioners and obstetricians are of utmost importance in women who are at risk and those living with psychiatric illnesses during pregnancy and puerperium. Practitioners should also ensure that women with impaired capacity due to psychiatric disease are treated in a non-judgmental and respectful manner, even if their autonomies have been overridden.
Collapse
Affiliation(s)
- Lindokuhle Thela
- University of KwaZulu Natal, School of Clinical Medicine, Discipline of Psychiatry, South Africa.
| | - Saeeda Paruk
- University of KwaZulu Natal, School of Clinical Medicine, Discipline of Psychiatry, South Africa
| | - Busisiwe Bhengu
- University of KwaZulu Natal, School of Clinical Medicine, Discipline of Psychiatry, South Africa
| | - Bonginkosi Chiliza
- University of KwaZulu Natal, School of Clinical Medicine, Discipline of Psychiatry, South Africa
| |
Collapse
|
3
|
Fitch MI, Hynie M. Editorial: Focus on maternal mental health during pregnancy and after childbirth. Front Glob Womens Health 2024; 5:1393215. [PMID: 38770440 PMCID: PMC11103008 DOI: 10.3389/fgwh.2024.1393215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/23/2024] [Indexed: 05/22/2024] Open
Affiliation(s)
- Margaret I. Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Michaela Hynie
- Department of Psychology/Centre for Refugee Studies, York University, Toronto, ON, Canada
| |
Collapse
|
4
|
Franzoi IG, Sauta MD, De Luca A, Granieri A. Returning to work after maternity leave: a systematic literature review. Arch Womens Ment Health 2024:10.1007/s00737-024-01464-y. [PMID: 38575816 DOI: 10.1007/s00737-024-01464-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE Working women often experience difficulties associated with balancing family and career, particularly if they choose to have children. This systematic literature review aimed at investigating women's experience in returning to work after maternity leave. METHODS The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The literature search led to the identification of 52 articles, which underwent data extraction and qualitative analysis. RESULTS Results were organized in 5 categories: (1) Work-life balance; (2) Women's mental and physical health; (3) Job-related wellbeing and working experience; (4) Breastfeeding. Women's both mental and physical health seem connected to a longer maternity leave and a greater coworkers' and supervisors' support. Returning to work seems to constitute one of the most important barriers for exclusive breastfeeding or breastfeeding continuation. A shorter duration of maternity leave, a higher workload and the lack of occupational policies supporting breastfeeding seem to be hindering factors. Partner and family support, and the opportunity for fathers to work under a flextime system after childbirth seem to increase both breastfeeding initiation and duration. Women who continue breastfeeding after returning to work seem to experience more family-to-work conflict and overload. CONCLUSIONS This paper show that there are still many understudied aspects in exploring women's experience of returning to work after maternity leave. This represents an important gap in the literature, since returning to work represents a particularly critical time in women's personal and occupational life, in which challenges and barriers may arise, potentially affecting their experience in the immediate future and years to come.
Collapse
Affiliation(s)
| | - Maria Domenica Sauta
- Department of Psychology, University of Turin, Via Verdi 10, Turin, 10124, Italy
| | - Alessandra De Luca
- Department of Psychology, University of Turin, Via Verdi 10, Turin, 10124, Italy
| | - Antonella Granieri
- Department of Psychology, University of Turin, Via Verdi 10, Turin, 10124, Italy
| |
Collapse
|
5
|
Platt IS, Pendl-Robinson EL, Dehus E, O'Neil SS, Vohra D, Kenny M, Pentenrieder L, Zivin K. Societal costs of untreated perinatal mood and anxiety disorders in Vermont. Arch Womens Ment Health 2024:10.1007/s00737-024-01429-1. [PMID: 38321244 DOI: 10.1007/s00737-024-01429-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 01/19/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE To estimate the societal costs of untreated perinatal mood and anxiety disorders (PMADs) in Vermont for the 2018-2020 average annual birth cohort from conception through five years postpartum. METHODS We developed a cost analysis model to calculate the excess cases of outcomes attributed to PMADs in the state of Vermont. Then, we modeled the associated costs of each outcome incurred by birthing parents and their children, projected five years for birthing parents who do not achieve remission by the end of the first year postpartum. RESULTS We estimated that the total societal cost of untreated PMADs in Vermont could reach $48 million for an annual birth cohort from conception to five years postpartum, amounting to $35,910 in excess societal costs per birthing parent with an untreated PMAD and their child. CONCLUSION Our model provides evidence of the high costs of untreated PMADs for birthing parents and their children in Vermont. Our estimates for Vermont are slightly higher but comparable to national estimates, which are $35,500 per birthing parent-child pair, adjusted to 2021 US dollars. Investing in perinatal mental health prevention and treatment could improve health outcomes and reduce economic burden of PMADs on individuals, families, employers, and the state.
Collapse
Affiliation(s)
- Isabel S Platt
- Mathematica, 1100 First Street, NE, 12th Floor, Washington, DC, 20002, USA.
| | | | - Eric Dehus
- Mathematica, 1100 First Street, NE, 12th Floor, Washington, DC, 20002, USA
| | - Sasigant So O'Neil
- Mathematica, 1100 First Street, NE, 12th Floor, Washington, DC, 20002, USA
| | - Divya Vohra
- Mathematica, 1100 First Street, NE, 12th Floor, Washington, DC, 20002, USA
| | - Michael Kenny
- Vermont Department of Health, 108 Cherry Street, Burlington, VT, 05402, USA
| | - Laura Pentenrieder
- Vermont Department of Health, 108 Cherry Street, Burlington, VT, 05402, USA
| | - Kara Zivin
- Mathematica, 1100 First Street, NE, 12th Floor, Washington, DC, 20002, USA
| |
Collapse
|
6
|
Xu Y, Zheng P, Feng W, Chen L, Sun S, Liu J, Tang W, Bao C, Xu L, Xu D, Zhao K. Patterns of attentional bias in antenatal depression: an eye-tracking study. Front Behav Neurosci 2023; 17:1288616. [PMID: 38192488 PMCID: PMC10773570 DOI: 10.3389/fnbeh.2023.1288616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/07/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction One of the most common mental disorders in the perinatal period is depression, which is associated with impaired emotional functioning due to alterations in different cognitive aspects including thought and facial emotion recognition. These functional impairment may affect emerging maternal sensitivity and have lasting consequences for the dyadic relationship. The current study aimed to investigate the impact of depressive symptoms on the attention bias of infant stimuli during pregnancy. Methods Eighty-six pregnant women completed the Edinburgh Postnatal Depression Scale and an eye-tracking task comprising infant-related emotion images. All participants showed biased attention to infant-related images. Results First, compared to healthy pregnant women, pregnant women with depression symptoms initially directed their attention to infant-related stimuli more quickly (F (1, 84) = 6.175, p = 0.015, η2 = 0.068). Second, the two groups of pregnant women paid attention to the positive infant stimuli faster than the neutral infant stimuli, and the first fixation latency bias score was significantly smaller than that of the infant-related negative stimulus (p = 0.007). Third, compared with the neutral stimulus, the non-depression group showed a longer first gaze duration to the negative stimulus of infants (p = 0.019), while the depressive symptoms group did not show this difference. Conclusion We speculate that structural and functional changes in affective motivation and cognitive-attention brain areas may induce these attentional bias patterns. These results provide suggestions for the implementation of clinical intervention programs to correct the attention bias of antenatal depressed women.
Collapse
Affiliation(s)
- Yao Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Peiwen Zheng
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Wenqian Feng
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, Chengdu, China
| | - Lipeng Chen
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Shiyu Sun
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Jie Liu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Weina Tang
- Shaoxing 7th People’s Hospital, Shaoxing, China
| | - Ciqing Bao
- Wenzhou Seventh People’s Hospital, Wenzhou, China
| | - Ling Xu
- Wenzhou Seventh People’s Hospital, Wenzhou, China
| | - Dongwu Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Ke Zhao
- Lishui Second People’s Hospital Affiliated to Wenzhou Medical University, Lishui, China
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, China
| |
Collapse
|
7
|
An S, Sun S. Serial multiple mediation of perceived professional healthcare support and social structural factors in the relationship between care-seeking behavior and perinatal mental health in Chinese mothers. BMC Public Health 2023; 23:2386. [PMID: 38041013 PMCID: PMC10691162 DOI: 10.1186/s12889-023-17310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND In previous studies, it has been observed that mother's perinatal mental health (PMH) problems can be improved by engaging in appropriate health care-seeking behaviors. However, the exact mechanism that influences the relationship between these two factors is still not fully understood. This cross-sectional study aims to examine the serial multiple mediating effects of perceived professional healthcare support (PPHS) and social structural factors on the association between care-seeking behavior and PMH. METHODS The cross-sectional study evaluated 1705 Chinese mothers (pregnancy 12 to 41 weeks) through questionnaires from October 2021 to November 2022. These mothers were selected from three hospitals in Wuxi, with an annual delivery volume of at least 5000. We conducted a structural equation model (SEM) analysis to examine the multiple mediating effect of PPHS and social structural factors (social stigma or social trust) between care-seeking behavior and PMH. After analyzing the results of the SEM, we used bootstrapping to further test the mediating effect. RESULTS Among the 1705 Chinese mothers surveyed, 636 (37.3%) sought help from professionals. It was observed that more women tended to seek professional help during the early stages of pregnancy (12 to 28 weeks) compared to the later stages (28 to 41 weeks) (t = 1.47, p < 0.05). The results of the SEM analysis indicated that the mother's care-seeking behavior did not have a significant direct effect on PMH. However, it was identified as a crucial distal variable, with its significant effect being fully mediated by PPHS and social structural factors. The mediation effect of PPHS and social stigma on the pathway from care-seeking behavior to PMH was found to be 92.9% (direct effect = 0.002; indirect effect = 0.026). Additionally, the mediating effect of stigma contributed to 21.9% of the association between care-seeking behavior and PPHS (direct effect = 0.405; indirect effect = 0.114). Similarly, the mediation effect of PPHS and social trust on the pathway from care-seeking behavior to PMH was 73.3% (direct effect = 0.008; indirect effect = 0.022). Moreover, the mediating effect of social trust contributed to 22.0% of the association between care-seeking behavior and PPHS (direct effect = 0.407; indirect effect = 0.115). The proposed model showed a good fit with the collected data. CONCLUSION This study examines the serial multiple mediation effect, in which PPHS and social structural factors mediate the relationship between PMH and professional care-seeking behavior. We suggest three levels of intervention: implementing mental health in all policies, providing training for healthcare providers, and establishing healthcare channels with easily accessible information.
Collapse
Affiliation(s)
- Shanshan An
- Department of Social Medicine, Jiangnan University, Wuxi, 214122, China
| | - Sheng Sun
- Department of Social Medicine, Jiangnan University, Wuxi, 214122, China.
| |
Collapse
|
8
|
Sulley S, Adzrago D, Mamudu L, Odame EA, Atandoh PH, Tagoe I, Ruggieri D, Kahle L, Williams F. Assessment of prenatal depression among U.S. pregnant women without access to paid sick leave and regular place of care: National Health Interview Survey of U.S.-born and non-U.S.-born. Prev Med Rep 2023; 35:102322. [PMID: 37554349 PMCID: PMC10404555 DOI: 10.1016/j.pmedr.2023.102322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 08/10/2023] Open
Abstract
Prenatal depression is one of the most common risks during pregnancy. This study examined the prevalence and likelihood of prenatal depression association with sociodemographic factors, paid sick leave, and place of care among U.S. pregnant women. We conducted bivariate Chi-square tests to assess the statistical difference and multivariable logistic regression models to assess the association of prenatal depression using the National Health Interview Survey, cross-sectional data from 2010 to 2019 of pregnant women aged 18-44 years (N = 957). The prevalence of prenatal depression was 40.6%, 28.5%, and 27.2% among White, Black, and other racial pregnant women, respectively. Pregnant women with no regular/routine place of care had a prenatal depression prevalence rate of 58.1%, and those without access to paid sick leave had 46.9%. Also, pregnant women without access to paid sick leave were found to have an increased likelihood of reporting prenatal depression ([adjusted odds ratio] AOR = 2.50, 95% CI = 1.72-3.64), as well as those without a regular place of care (AOR = 2.43, 95% CI = 1.32-4.47). The findings identify factors that need to be addressed to minimize depression among U.S. pregnant women and establish the need for tailored interventions to address prenatal depression.
Collapse
Affiliation(s)
- Saanie Sulley
- National Healthy Start Association, Washington, DC, USA
| | - David Adzrago
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Lohuwa Mamudu
- Department of Public Health, California State University, Fullerton, CA, USA
| | - Emmanuel A. Odame
- Department of Environmental Health Sciences, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul H. Atandoh
- Department of Statistics, Western Michigan University, Kalamazoo, MI, USA
| | - Ishmael Tagoe
- Division of Health Services, College of Nursing and Advanced Health Professions, The Chicago School of Professional Psychology, Chicago, IL, USA
| | - David Ruggieri
- Information Management Services, Inc., Calverton, MD, USA
| | - Lisa Kahle
- Information Management Services, Inc., Calverton, MD, USA
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
9
|
Zargar M, Sayyah M, Nikbakht R, Abdipour Z. Comparison of psychological disorders during and after pregnancies caused by assisted reproductive treatments and spontaneous pregnancies. Cent Nerv Syst Agents Med Chem 2023; 23:CNSAMC-EPUB-133742. [PMID: 37592788 DOI: 10.2174/1871524923666230817102216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/24/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Mental disorders during pregnancy are one of the major public health problems because of its effect on both mother and child, but the prevalence of psychiatric disorders in infertile women is largely unknown to compare psychiatric disorders during and after pregnancies with assisted reproductive therapies (ART) and spontaneous pregnancies. METHODS This cross-sectional study was conducted on pregnant women referring to midwifery centers in Ahvaz City in 2022. Pregnant women were included in two groups of either pregnancy caused by ART (n= 84) or spontaneous pregnancy (n= 256). The Symptom Checklist-90-R (SCL90-R) was used to assess psychiatric disorders during and after pregnancies. RESULTS A high percentage of women with spontaneous pregnancy (74.6%) and ART (91.7%) had some degree of psychological disorders. The severity of psychological disorders in both groups was higher during pregnancy than after pregnancy (P<0.001). The intensity of various psychological disorders during and after pregnancy in the ART pregnancy group was significantly higher than the control group (P<0.001). An increased risk of psychiatric disorders during pregnancy was associated with the history of psychiatric disorders [odd ratio (OR): 12.393; P= 0.022], family history of psychiatric disorders (OR:26.168; P<0.001), history of infertility (OR: 19.00; P<0.001), primary infertility (OR: 12.714; P=0.004), infertility duration more than three years (OR: 43.424; P<0.001), and frequency of embryo transfer (OR: 18.939; P=0.045). CONCLUSION Psychiatric disorders were prevalent among pregnant women in the study area especially in pregnant women with ART. Regular screening programs for mental health problem should be included in an antenatal care service especially in this high-risk group.
Collapse
Affiliation(s)
- Mahvash Zargar
- Department of Obstetrics and Gynecology, School of Medicine, Fertility Infertility and Perinatology Research Center,
Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehdi Sayyah
- Educational Development Center, Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Roshan Nikbakht
- Department of Obstetrics and Gynecology, School of Medicine, Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zahra Abdipour
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
10
|
Awini E, Agyepong IA, Owiredu D, Gyimah L, Ashinyo ME, Yevoo LL, Aye SGEV, Abbas S, Cronin de Chavez A, Kane S, Mirzoev T, Danso-Appiah A. Burden of mental health problems among pregnant and postpartum women in sub-Saharan Africa: systematic review and meta-analysis protocol. BMJ Open 2023; 13:e069545. [PMID: 37286328 DOI: 10.1136/bmjopen-2022-069545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION Pregnancy and postpartum-related mental health problems pose serious public health threat to the society, but worryingly, neglected in sub-Saharan Africa (SSA). This review will assess the burden and distribution of maternal mental health (MMH) problems in SSA, with the aim to inform the implementation of context sensitive interventions and policies. METHODS AND ANALYSIS All relevant databases, grey literature and non-database sources will be searched. PubMed, LILAC, CINAHL, SCOPUS and PsycINFO, Google Scholar, African Index Medicus, HINARI, African Journals Online and IMSEAR will be searched from inception to 31 May 2023, without language restriction. The reference lists of articles will be reviewed, and experts contacted for additional studies missed by our searches. Study selection, data extraction and risk of bias assessment will be done independently by at least two reviewers and any discrepancies will be resolved through discussion between the reviewers. Binary outcomes (prevalence and incidence) of MMH problems will be assessed using pooled proportions, OR or risk ratio and mean difference for continuous outcomes; all will be presented with their 95% CIs. Heterogeneity will be investigated graphically for overlapping CIs and statistically using the I2 statistic and where necessary subgroup analyses will be performed. Random-effects model meta-analysis will be conducted when heterogeneity is appreciable, otherwise fixed-effect model will be used. The overall level of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation. ETHICS AND DISSEMINATION Although no ethical clearance or exemption is needed for a systematic review, this review is part of a larger study on maternal mental health which has received ethical clearance from the Ethics Review Committee of the Ghana Health Service (GHS-ERC 012/03/20). Findings of this study will be disseminated through stakeholder forums, conferences and peer review publications. PROSPERO REGISTRATION NUMBER CRD42021269528.
Collapse
Affiliation(s)
- Elizabeth Awini
- Research and Development Division, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana
| | - Irene Akua Agyepong
- Research and Development Division, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - David Owiredu
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
| | - Leveana Gyimah
- Department of Psychiatry, Pantang Hospital, Accra, Ghana
- Faculty of Psychiatry, Ghana College of Physicians and Surgeons, Accra, Ghana
| | | | - Linda Lucy Yevoo
- Research and Development Division, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana
| | - Sorre Grace Emmanuelle Victoire Aye
- Research and Development Division, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Shazra Abbas
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Anna Cronin de Chavez
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Tolib Mirzoev
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Anthony Danso-Appiah
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
- Centre for Evidence Synthesis and Policy, University of Ghana, Legon, Accra, Ghana
| |
Collapse
|
11
|
Stentzel U, Grabe HJ, Schmidt S, Tomczyk S, van den Berg N, Beyer A. Mental health-related telemedicine interventions for pregnant women and new mothers: a systematic literature review. BMC Psychiatry 2023; 23:292. [PMID: 37118689 PMCID: PMC10148488 DOI: 10.1186/s12888-023-04790-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 04/14/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Pregnancy and the postpartum period are times when women are at increased risk for depression and mental problems. This may also negatively affect the foetus. Thus, there is a need for interventions with low-threshold access and care. Telemedicine interventions are a promising approach to address these issues. This systematic literature review examined the efficacy of telemedicine interventions for pregnant women and/or new mothers to address mental health-related outcomes. The primary objective was to analyse whether telemedicine interventions can reduce mental health problems in pregnant women and new mothers. The secondary aim was to clarify the impact of type of interventions, their frequency and their targets. METHODS Inclusion criteria: randomized controlled trials, with participants being pregnant women and/or new mothers (with infants up to twelve months), involving telemedicine interventions of any kind (e.g. websites, apps, chats, telephone), and addressing any mental health-related outcomes like depression, postnatal depression, anxiety, stress and others. Search terms were pregnant women, new mothers, telemedicine, RCT (randomised controlled trials), mental stress as well as numerous synonyms including medical subject headings. The literature search was conducted within the databases PubMed, Cochrane Library, Web of Science and PsycINFO. Screening, inclusion of records and data extraction were performed by two researchers according to the PRISMA guidelines, using the online tool CADIMA. RESULTS Forty four articles were included. A majority (62%) reported significantly improved mental health-related outcomes for participants receiving telemedicine interventions compared to control. In particular (internet-delivered) Cognitive Behavioural Therapy was successful for depression and stress, and peer support improved outcomes for postnatal depression and anxiety. Interventions with preventive approaches and interventions aimed at symptom reduction were largely successful. For the most part there was no significant improvement in the symptoms of anxiety. CONCLUSION Telemedicine interventions evaluated within RCTs were mostly successful. However, they need to be designed to specifically target a certain mental health issue because there is no one-size-fits-all approach. Further research should focus on which specific interventions are appropriate for which mental health outcomes in terms of intervention delivery modes, content, target approaches, etc. Further investigation is needed, in particular with regard to anxiety.
Collapse
Affiliation(s)
- Ulrike Stentzel
- Institute for Community Medicine, University Medicine Greifswald, Section Epidemiology of Health Care and Community Health, Ellernholzstraße 1-2, 17489, Greifswald, Germany.
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Ellernholzstraße 1-2, 17489, Greifswald, Germany
| | - Silke Schmidt
- Department Health and Prevention, Institute of Psychology, University of Greifswald, Greifswald, Germany
| | - Samuel Tomczyk
- Department Health and Prevention, Institute of Psychology, University of Greifswald, Greifswald, Germany
| | - Neeltje van den Berg
- Institute for Community Medicine, University Medicine Greifswald, Section Epidemiology of Health Care and Community Health, Ellernholzstraße 1-2, 17489, Greifswald, Germany
| | - Angelika Beyer
- Institute for Community Medicine, University Medicine Greifswald, Section Epidemiology of Health Care and Community Health, Ellernholzstraße 1-2, 17489, Greifswald, Germany
| |
Collapse
|
12
|
Anxiety, stress, and depression in Australian pregnant women during the COVID-19 pandemic: A cross sectional study. Midwifery 2023; 119:103619. [PMID: 36812820 PMCID: PMC9933579 DOI: 10.1016/j.midw.2023.103619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 08/08/2022] [Accepted: 02/02/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND The COVID-19 pandemic necessitated rapid responses by health services to suppress transmission of the virus. AIM This study aimed to investigate predictors of anxiety, stress and depression in Australian pregnant women during the COVID-19 pandemic including continuity of carer and the role of social support. METHODS Women aged 18 years and over in their third trimester of pregnancy were invited to complete an online survey between July 2020 and January 2021. The survey included validated tools for anxiety, stress, and depression. Regression modelling was used to identify associations between a range of factors including continuity of carer, and mental health measures. FINDINGS 1668 women completed the survey. One quarter screened positive for depression, 19% for moderate or higher range anxiety, and 15.5% for stress. The most significant contribution to higher anxiety, stress, and depression scores was a pre-existing mental health condition, followed by financial strain and a current complex pregnancy. Protective factors included age, social support, and parity. DISCUSSION Maternity care strategies to reduce COVID-19 transmission restricted women's access to their customary pregnancy supports and increased their psychological morbidity. CONCLUSION Factors associated with anxiety, stress and depression scores during the COVID-19 pandemic were identified. Maternity care during the pandemic compromised pregnant women's support systems.
Collapse
|
13
|
Mikolajkow A, Małyszczak K. Stress level and general mental state in Polish pregnant women during COVID-19 pandemic. J Reprod Infant Psychol 2023; 41:165-182. [PMID: 34555951 DOI: 10.1080/02646838.2021.1976402] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION COVID-19 pandemic may contribute to mental state worsening. Mental health disorders in pregnancy are known to have adverse outcomes both for mothers and their children. It is the first study in Poland to investigate the impact of the pandemic on stress level and general mental state in pregnant women. METHODS Three hundred sixteen pregnant women completed an online survey containing four instruments. The main research questions were investigated with Bayesian regression analyses. RESULTS We found that 37% of pregnant women presented with some mental state disorders and almost 46% with elevated emotional tension. Seventeen % had elevated stress level, 11% elevated intrapsychic stress level and 13% elevated outward stress level. Both 'being scared of lack of social support...' and 'being scared of infection...' have an impact on stress level, however the first factor is a more substantial stressor. CONCLUSIONS Multiple pregnant women during the Coronavirus SARS-CoV-2 pandemic presented with mental state disorders and elevated stress levels. As mental state disorders contribute to adverse neonatal outcomes and maternal mortality, it is imperative to focus on pregnant women's psychological and psychiatric conditions during the pandemic. It seems crucial to use screening tests to make early psychiatric diagnoses.
Collapse
Affiliation(s)
- Agata Mikolajkow
- Department and Clinic of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Małyszczak
- Department and Clinic of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| |
Collapse
|
14
|
Shariatpanahi M, Faramarzi M, Barat S, Farghadani A, Shirafkan H. Acceptability, feasibility, and effectiveness of internet-based emotion-focused cognitive behavior therapy with husband participation for Iranian pregnant women with anxiety disorder. INTERNATIONAL JOURNAL OF SYSTEMIC THERAPY 2023. [DOI: 10.1080/2692398x.2023.2174773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
- Mojgan Shariatpanahi
- Psychology, Department of Psychology, Saveh Branch, Islamic Azad University, Saveh, Iran
| | - Mahbobeh Faramarzi
- Psychology, Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Shahnaz Barat
- Obstetrics and Gynecology, Infertility and Health Reproductive Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Azadeh Farghadani
- Department of Psychology, Saveh Branch, Islamic Azad University, Saveh, Iran
| | - Hoda Shirafkan
- Biostatistics, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| |
Collapse
|
15
|
Cummins A, Baird K, Melov SJ, Melhem L, Hilsabeck C, Hook M, Elhindi J, Pasupathy D. Does midwifery continuity of care make a difference to women with perinatal mental health conditions: A cohort study, from Australia. Women Birth 2023; 36:e270-e275. [PMID: 35941058 DOI: 10.1016/j.wombi.2022.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Perinatal mental health (PMH) conditions are associated with an increased risk of adverse perinatal outcomes including preterm birth. Midwifery caseload group practice (continuity of care, MCP) improves perinatal outcomes including a 24 % reduction of preterm birth. The evidence is unclear whether MCP has the same effect for women with perinatal mental health conditions. AIM To compare perinatal outcomes in women with a mental health history between MCP and standard models of maternity care. The primary outcome measured the rates of preterm birth. METHODS A retrospective cohort study using routinely collected data of women with PMH conditions between 1st January 2018 - 31st January 2021 was conducted. We compared characteristics and outcomes between groups. Multivariate logistic regression models were performed adjusting for a-priori selected variables and factors that differ between models of care. RESULTS The cohort included 3028 women with PMH, 352 (11.6 %) received MCP. The most common diagnosis was anxiety and depression (n = 723, 23.9 %). Women receiving MCP were younger (mean 30.9 vs 31.3, p = 0.03), Caucasian (37.8 vs 27.1, p < 0.001), socio-economically advantaged (31.0 % vs 20.2, p < 0.001); less likely to smoke (5.1 vs 11.9, p < 0.001) and with lower BMI (mean 24.3 vs 26.5, p < 0.001) than those in the standard care group. Women in MCP had lower odds of preterm birth (adjOR 0.46, 95 % CI 0.24-0.86), higher odds of vaginal birth (adjOR 2.55, 95 % CI 1.93-3.36), breastfeeding at discharge (adj OR 3.06, 95 % CI 2.10-4.55) with no difference in severe adverse neonatal outcome (adj OR 0.79, 95 % CI 0.57-1.09). CONCLUSIONS This evidence supports MCP for women with PMH. Future RCTs on model of care for this group of women is needed to establish causation.
Collapse
Affiliation(s)
- Allison Cummins
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Australia.
| | - Kathleen Baird
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, 235 Jones St, Ultimo, NSW 2007, Australia
| | - Sarah J Melov
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Australia; Westmead Institute for Maternal and Fetal Medicine, Women's and Newborn Health, Westmead Hospital, NSW, Australia
| | - Lena Melhem
- Women's and Newborn's Health, Westmead Hospital, Western Sydney Local Health Districts, Australia
| | - Carolyn Hilsabeck
- Women's and Newborn's Health, Westmead Hospital, Western Sydney Local Health Districts, Australia
| | - Monica Hook
- Women's and Newborn's Health, Westmead Hospital, Western Sydney Local Health Districts, Australia
| | - James Elhindi
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Australia
| | - Dharmintra Pasupathy
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Australia; Westmead Institute for Maternal and Fetal Medicine, Women's and Newborn Health, Westmead Hospital, NSW, Australia
| |
Collapse
|
16
|
Kallas KA, Marr K, Moirangthem S, Heude B, Koehl M, van der Waerden J, Downes N. Maternal Mental Health Care Matters: The Impact of Prenatal Depressive and Anxious Symptoms on Child Emotional and Behavioural Trajectories in the French EDEN Cohort. J Clin Med 2023; 12:jcm12031120. [PMID: 36769767 PMCID: PMC9917852 DOI: 10.3390/jcm12031120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/21/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
Few studies have investigated longitudinal trajectories of child socioemotional and behavioural development in relation to maternal prenatal mental health exposure or taken into consideration of the potential buffering effects of psychological intervention during pregnancy. Using data from 1135 mother-child dyads from the EDEN cohort from the general French population, Group-based trajectory modelling was used to model trajectories of behavioural and emotional characteristics measured at four timepoints via a parent-administered Strengths and Difficulties Questionnaire. Using propensity scores and inverse probability weighting to account for confounding factors, multinomial logistic regressions were used to quantify the associations with maternal symptoms of prenatal depression and anxiety. Stratified analyses were conducted by reporting psychologist and psychiatrist consultations during pregnancy. Compared to those without psychological problems, children of mothers with comorbid anxiety and depression retained a higher probability of following high and intermediate trajectories of emotional problems and a high trajectory of conduct problems throughout childhood. This increased risk was not present in the children of mothers who sought support through a prenatal psychologist or psychiatrist consultation. This article adds to a body of evidence underlining the importance of mental health care for expecting mothers.
Collapse
Affiliation(s)
- Kadri-Ann Kallas
- Social Epidemiology Research Team, Institut Pierre Louis d’Épidémiologie et de Santé Publique, INSERM U1136, Sorbonne Université, 75012 Paris, France
| | - Ketevan Marr
- Social Epidemiology Research Team, Institut Pierre Louis d’Épidémiologie et de Santé Publique, INSERM U1136, Sorbonne Université, 75012 Paris, France
| | - Simi Moirangthem
- Social Epidemiology Research Team, Institut Pierre Louis d’Épidémiologie et de Santé Publique, INSERM U1136, Sorbonne Université, 75012 Paris, France
| | - Barbara Heude
- Orchad Team, Epidemiology and Biostatistics Sorbonne Paris Cité Center, INSERM UMR1153, INRAE, Université de Paris, 75001 Paris, France
| | - Muriel Koehl
- Neurogenesis and Pathophysiology Group, Neurocentre Magendie, INSERM U1215, Université de Bordeaux, 33000 Bordeaux, France
| | - Judith van der Waerden
- Social Epidemiology Research Team, Institut Pierre Louis d’Épidémiologie et de Santé Publique, INSERM U1136, Sorbonne Université, 75012 Paris, France
- Correspondence:
| | - Naomi Downes
- Social Epidemiology Research Team, Institut Pierre Louis d’Épidémiologie et de Santé Publique, INSERM U1136, Sorbonne Université, 75012 Paris, France
| |
Collapse
|
17
|
Schauer M, Latartara E, Alonso-Espias M, Rossetti E, Gebert P, Henrich W, Hinkson L. Depression, anxiety and stress in women with breech pregnancy compared to women with cephalic presentation-a cross-sectional study. Arch Gynecol Obstet 2023; 307:409-419. [PMID: 35344082 PMCID: PMC9918572 DOI: 10.1007/s00404-022-06509-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/04/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aims to evaluate the level of psychological distress for women with breech compared to cephalic presentation. We hypothesized, that women with breech presentation have higher levels of depression, stress and anxiety. Secondary objectives were to analyze potential demographic risk factors and comorbidity of psychological distress in breech pregnancy. METHODS The breech study group was formed by 379 women with breech presentation. A sample of 128 women with cephalic presentation was recruited during routine clinical care. Depression, anxiety and stress symptoms were ascertained by means of the Depression-Anxiety-Stress-Score (DASS)-21 questionnaire. Categorial data was analyzed with Chi-square or exact test, continuous data with unpaired t test or Mann-Whitney U test. Demographic risk factors were identified using a binary logistic regression model. RESULTS Prevalence of psychological distress among women with breech was not higher compared to those of other pregnant women. Symptomatic depression, anxiety and stress affected 5.8%, 14.5% and 11.9% of women with breech, respectively. Decreasing age was identified as a risk factor for anxiety (p = 0.006). Multiparity increased risk for depression (p = 0.001), for anxiety (p = 0.026) and for perinatal stress (p = 0.010). More than 80% of women with depressive symptoms had comorbidities of psychological distress. CONCLUSIONS Breech presentation compared to cephalic presentation was not associated with higher levels of psychological distress. However, breech pregnancies are affected by symptoms of potential mental disorder. Multiparous women and younger women may need additional support and would benefit from a standardized screening tool for the assessment of perinatal psychological distress. CLINICAL TRIAL REGISTRATION Ethical approval (EA2/241/18) was granted by the Ethics Commission of the Charité University Hospital on the 23.01.2019 (ClinicalTrials.gov Identifier: NCT03827226).
Collapse
Affiliation(s)
- Madeleine Schauer
- Department of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany
| | - Elisabetta Latartara
- Department of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany
- Università Cattolica del Sacro Cuore Largo Francesco Vito, Rome, Italy
| | - Maria Alonso-Espias
- Department of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany
- La Paz University Hospital, Madrid, Spain
| | - Emma Rossetti
- Department of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany
- University of Udine, Udine, Italy
| | - Pimrapat Gebert
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany
| | - Larry Hinkson
- Department of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany.
- , 8. Floor, Bettenhochhaus, Campus Mitte, Chariteplatz 1, 10117, Berlin, Germany.
| |
Collapse
|
18
|
Slade P, Balling K, Houghton G, Sheen K. A new scale for fear of childbirth: the Fear of Childbirth Questionnaire (FCQ). J Reprod Infant Psychol 2022; 40:602-612. [PMID: 34027771 DOI: 10.1080/02646838.2021.1928615] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To create a clear and acceptable measure of fear of childbirth with satisfactory content validity for use with English-speaking women in the UK. BACKGROUND Fear of childbirth (FOC) can have a significant impact on a woman's view of her pregnancy, birth and her recovery post birth. Early identification is paramount to ensure that women's needs are recognised so that appropriately tailored care can be provided in pregnancy. Availability of reliable and valid measures to assess FOC in an English-speaking population are sparse, mainly due to issues with definitions of FOC or cultural sensitivity after translation. Recent research from phase one of the Fear of Childbirth study (FOCUS), has established key elements for FOC in an English-speaking UK population, and allows for a culturally sensitive measure of FOC to be developed. The aim was to ensure inclusion of all ten FOC elements and to attend to guidance from women in phase two of the FOCUS study about what would ensure clarity and acceptability. METHOD A multidisciplinary team developed items in accordance with FOCUS. The measure was then piloted with one reviewer and further refined by the team of perinatal researchers. RESULTS The FCQ is a new 20-item fear of childbirth questionnaire, which has been developed and is grounded in fears reported by women in the UK. CONCLUSION A new tool to measure FOC in an English-speaking UK population with good content validity has undergone a preliminary phase of development and now needs testing for reliability and other forms of validity.
Collapse
Affiliation(s)
- Pauline Slade
- Department of Mental Health and Primary Care, Institute of Public Health, University of Liverpool, Liverpool, UK
| | - Katie Balling
- Department of Mental Health and Primary Care, Institute of Public Health, University of Liverpool, Liverpool, UK
| | | | - Kayleigh Sheen
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| |
Collapse
|
19
|
Trinh TG, Schwarze CE, Müller M, Goetz M, Hassdenteufel K, Wallwiener M, Wallwiener S. Implementing a Perinatal Depression Screening in Clinical Routine: Exploring the Patient's Perspective. Geburtshilfe Frauenheilkd 2022; 82:1082-1092. [PMID: 36186149 PMCID: PMC9525145 DOI: 10.1055/a-1844-9246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/08/2022] [Indexed: 11/01/2022] Open
Abstract
Introduction Perinatal depression (PND) is a frequently observed mental disorder, showing a prevalence of up to 20% and resulting in unfavorable maternal and neonatal outcomes. Targeted screening for PND offers the potential to identify and treat undiagnosed cases and help prevent its deleterious consequences. The aim of the present study was to evaluate participants' personal attitudes and acceptance of a routine screening program for PND in pregnancy care, identify any potential underlying factors, and appraise the general perspective on perinatal mental health problems. Methods In total, 732 women in their second trimester of pregnancy took part in a PND screening program that was incorporated in routine prenatal care using the Edinburgh Postnatal Depression Scale (EPDS) and completed a web-based survey on screening acceptance. Results Participants viewed PND screening as useful (78.7%, n = 555/705), especially in terms of devoting attention to perinatal mental health problems (90.1%, n = 630/699), easy to complete (85.4%, n = 606/710), and without feelings of discomfort (88.3%, n = 628/711). Furthermore, women with previous or current mental health issues rated the usefulness of screening significantly higher, as did women with obstetric risks (p < 0.01 - p = 0.04). The final regression model explained 48.4% of the variance for screening acceptance. Conclusion Patient acceptance for PND screening was high in our study cohort, supporting the implementation of screening programs in routine pregnancy care with the potential to identify, sensitize, and treat undiagnosed patients to reduce stigmatization and offer access to tailored dedicated PND care programs.
Collapse
Affiliation(s)
- Thuy Giang Trinh
- Department of Obstetrics and Gynecology, Heidelberg University, Heidelberg, Germany
| | | | - Mitho Müller
- Department of Psychology, Ludwig Maximilian University, Munich, Germany
| | - Maren Goetz
- Department of General Pediatrics, University Childrenʼs Hospital, Heidelberg, Germany
| | | | - Markus Wallwiener
- Department of Obstetrics and Gynecology, Heidelberg University, Heidelberg, Germany
| | - Stephanie Wallwiener
- Department of Obstetrics and Gynecology, Heidelberg University, Heidelberg, Germany,Correspondence Prof. Stephanie Wallwiener, MD Department of Obstetrics and GynecologyHeidelberg
UniversityIm Neuenheimer Feld 44069120
HeidelbergGermany
| |
Collapse
|
20
|
Dörsam AF, Bye A, Graf J, Howard LM, Throm JK, Müller M, Wallwiener S, Zipfel S, Micali N, Giel KE. Screening instruments for eating disorders in pregnancy: Current evidence, challenges, and future directions. Int J Eat Disord 2022; 55:1208-1218. [PMID: 35844188 DOI: 10.1002/eat.23780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022]
Abstract
Pregnancy is a vulnerable period for eating disorder (ED) occurrence and maternal EDs are associated with heightened risk of adverse pregnancy and infant outcomes. This highlights the need to identify pregnant women with past or current EDs in order to offer appropriate support. However, there is a knowledge and practice gap on screening pregnant women for EDs. Clinical guidance is lacking in international treatment guidelines, which is unsurprising given that no validated ED screening tool specifically designed for use in antenatal populations exists. Moreover, data on the effectiveness of general population screening tools for identifying EDs in pregnant women are scarce. This article provides a synthesis of current evidence, treatment guidelines, and data on the diagnostic accuracy for screening for EDs in antenatal samples from three studies with different screening approaches. We outline recommendations for future steps to tackle the knowledge and practice gap on screening for EDs in pregnant women, including next steps for the development of a pregnancy-specific ED screener and the use of general mental health screeners to detect EDs during pregnancy. Up-to-date, the jury is still out as how to best identify current or past EDs in pregnancy. More research is needed to assess the efficacy of using general mental health screeners versus ED-specific screening instruments to detect ED in pregnancy. Additionally, clinicians have to be trained on how to assess and manage EDs during pregnancy. PUBLIC SIGNIFICANCE: Identifying pregnant women with eating disorders (EDs) is a public health concern which can be addressed using multiple approaches, including implementation of general and specific assessments within routine antenatal care, and training of healthcare professionals.
Collapse
Affiliation(s)
- Annica Franziska Dörsam
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany.,Center of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Amanda Bye
- Department of Psychological Medicine, Division of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Johanna Graf
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Louise M Howard
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jana Katharina Throm
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany.,Center of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Mitho Müller
- Department of Psychology, Ludwig Maximilian University, Munich, Germany
| | - Stephanie Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany.,Center of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Nadia Micali
- Department of Psychiatry, University of Geneva, Geneva, Switzerland.,Department of Pediatrics, Obstetrics and Gynecology, University of Geneva, Geneva, Switzerland.,Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany.,Center of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| |
Collapse
|
21
|
Saito J, Tachibana Y, Wada YS, Yakuwa N, Kawasaki H, Suzuki T, Sago H, Yamatani A, Murashima A. Transfer of brotizolam, periciazine, and sulpiride in cord blood and breast milk, and alprazolam in breast milk: a case report. J Pharm Health Care Sci 2022; 8:10. [PMID: 35361275 PMCID: PMC8973510 DOI: 10.1186/s40780-022-00241-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background A high prevalence of mental disorders including depression, anxiety, somatoform, and dissociative disorder is reported during pregnancy, however, information on the transfer of antipsychotics across the placenta and into breast milk is limited. We evaluated brotizolam, periciazine and sulpiride in cord blood, maternal serum, and breast milk, and alprazolam in breast milk. Case presentation A 38-year-old woman with dissociative disorder was treated with brotizolam, propericiazine, and sulpiride during pregnancy and lactation, and alprazolam during lactation. The drug concentration ratios for both cord blood and maternal serum were 33.3 and 61.5% for brotizolam and sulpiride, respectively, and periciazine (metabolite of propericiazine) was not detected in the cord blood. In breast milk, alprazolam (0.9 ng/mL), sulpiride (445.8 ng/mL), and periciazine (0.3 ng/mL) concentrations were noted at 7.5 h after the last dose on postpartum, whereas brotizolam was not detected. The relative infant doses via breast milk were 1.4, 2.7 and 0.02% of the maternal daily dose, respectively. The neonate had no congenital anomalies and did not experience any severe withdrawal symptoms after birth. Conclusion Use of brotizolam, propericiazine, and sulpiride during pregnancy and lactation, and use of alprazolam during lactation were acceptable in this case.
Collapse
Affiliation(s)
- Jumpei Saito
- Department of Pharmacy, National Center for Child Health and Development, Tokyo, Japan.
| | - Yoshiyuki Tachibana
- Division of Infant and Toddler Mental Health, Department of Psychosocial Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Yuka Sano Wada
- Division of Neonatology, Center for Maternal-Fetal, Neonatal, and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Naho Yakuwa
- Japan Drug Information Institute in Pregnancy, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroyo Kawasaki
- Department of Pharmacy, National Center for Child Health and Development, Tokyo, Japan
| | - Tomo Suzuki
- Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.,Division of Obstetrics, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Haruhiko Sago
- Division of Obstetrics, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Akimasa Yamatani
- Department of Pharmacy, National Center for Child Health and Development, Tokyo, Japan.,Japan Drug Information Institute in Pregnancy, National Center for Child Health and Development, Tokyo, Japan
| | - Atsuko Murashima
- Japan Drug Information Institute in Pregnancy, National Center for Child Health and Development, Tokyo, Japan.,Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
22
|
Runkle JD, Matthews JL, Sparks L, McNicholas L, Sugg MM. Racial and ethnic disparities in pregnancy complications and the protective role of greenspace: A retrospective birth cohort study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 808:152145. [PMID: 34871679 DOI: 10.1016/j.scitotenv.2021.152145] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 06/13/2023]
Abstract
Greenspace may positively impact pregnancy health for racially and economically minoritized populations; few studies have examined local availability and accessibility of green/park space in reducing maternal morbidity. The objective of this retrospective birth cohort study was to examine the association between residential exposure to greenspace and adverse pregnancy health outcomes in a Southern US state characterized by high poverty and racial disparities in maternal health (2013-2017). National data from the Protected Area database - United States (PAD-US) and ParkServe estimated three publicly available and accessible residential greenspace measures-a more direct proxy than using remotely-sensed greenness indicators (e.g., normalized difference vegetation index (NDVI))-(a) percent area of greenspace (M1), (b) area of available greenspace per person (M2), (c) total population within a 10-minute walk (M3). Generalized Estimating Equations with logistic regression were used to examine the association between individual greenspace metrics and South Carolina hospital deliveries (n = 238,922 deliveries) for women with correlated maternal health outcomes for gestational hypertension (GHTN), gestational diabetes (GD), severe maternal morbidity (SMM), preeclampsia (PRE), mental disorders (MD), depressive disorders (DD), and preterm birth (PTB). Lowest compared to highest tertiles of all three metrics were associated with increased risk for MD, DD, and a monotonic increase in GD, particularly for black women. Women with the lowest access to M2 and M3 were more at risk for PRE, PTB, and MD. We observed that women in low-income, majority-black communities in the lowest versus highest tertile of M2 were more likely to experience a DD, MD, SMM, or PTB compared to primarily high-income majority-white communities. Available and accessible green/park space may present as an effective nature-based intervention to reduce maternal complications, particularly for gestational diabetes and other pregnancy health risks for which there are currently few known evidence-based primary prevention strategies.
Collapse
Affiliation(s)
- Jennifer D Runkle
- North Carolina Institute for Climate Studies, North Carolina State University, 151 Patton Avenue, Asheville, NC 28801, USA.
| | - Jessica L Matthews
- NOAA's National Centers for Environmental Information (NCEI), 151 Patton Avenue, Asheville, NC 28801, USA.
| | - Laurel Sparks
- Department of Geosciences, Georgia State University, Atlanta, GA 30303, USA
| | - Leo McNicholas
- Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Margaret M Sugg
- Department of Geography and Planning, Appalachian State University, P.O. Box 32066, Boone, NC 28608, USA.
| |
Collapse
|
23
|
Schiele C, Goetz M, Hassdenteufel K, Müller M, Graf J, Zipfel S, Wallwiener S. Acceptance, experiences, and needs of hospitalized pregnant women toward an electronic mindfulness-based intervention: A pilot mixed-methods study. Front Psychiatry 2022; 13:939577. [PMID: 36072461 PMCID: PMC9444059 DOI: 10.3389/fpsyt.2022.939577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/28/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Anxiety disorders and depression during pregnancy are highly prevalent. Hospitalized pregnant women with high maternal or fetal risk represent a particularly vulnerable population often excluded from research samples. Screening for mental health disorders is not routinely offered for this particular patient group. Electronic mindfulness-based interventions constitute an accessible, convenient, and cost-effective mental health resource but have not yet been evaluated for acceptance in inpatient settings. To date, little is known about the needs and perceptions of this group of women. OBJECTIVE The aim of this study was to examine whether a brief electronic mindfulness-based intervention (eMBI) is accepted among hospitalized high-risk pregnant women. We assessed personal motivation and barriers, experiences, usability requirements, and overall acceptance of the eMBI, as well the specific needs and demands of patients with high-risk pregnancies regarding mental health services. METHODS An exploratory pilot study with a mixed-methods study design was carried out among 30 women hospitalized with a high obstetric risk. The study participants were given access to an eMBI with a 1-week mindfulness program on how to deal with stress, anxiety, and depressive symptoms. Semi-structured interviews were conducted with the 30 participants and analyzed using systematic content analysis. In addition, acceptance and usability were assessed via questionnaires. RESULTS Study findings showed a high level of acceptance of the eMBI. Most of the respondents were satisfied with the usability and considered the eMBI program to be helpful. The greatest barriers to using the eMBI were a general negative attitude toward using apps, preference for personal contact, or no current need for psychotherapy. Participants criticized the lack of awareness of mental health issues during pregnancy and expressed a need for low-threshold treatment offers, especially during hospitalization. CONCLUSIONS There is a strong need for mental health services in pregnancy care, especially for pregnant women with risk profiles. An eMBI offers an acceptable means of providing mental health support for hospitalized women with a severe obstetric risk.
Collapse
Affiliation(s)
- Claudia Schiele
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Maren Goetz
- Department of General Pediatrics, University of Heidelberg, Heidelberg, Germany
| | - Kathrin Hassdenteufel
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Mitho Müller
- Department of Psychology, Ludwig Maximilian University, Munich, Germany
| | - Johanna Graf
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Stephanie Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
24
|
Cena L, Gigantesco A, Mirabella F, Palumbo G, Camoni L, Trainini A, Stefana A. Prevalence of comorbid anxiety and depressive symptomatology in the third trimester of pregnancy: Analysing its association with sociodemographic, obstetric, and mental health features. J Affect Disord 2021; 295:1398-1406. [PMID: 34583842 DOI: 10.1016/j.jad.2021.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 08/09/2021] [Accepted: 09/12/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Little is known about the prevalence of comorbid anxiety and depression (CAD) during pregnancy and its risk factors. The aims of this study are to determine the prevalence of CAD in the third trimester of pregnancy and analyse its association with socio-demographic, obstetric, and mental health features. METHODS In a sample of 934 Italian pregnant women, CAD was defined as having (1) a score of ≥ 10 on the EPDS - depression subscale and/or on the PHQ-9, and (2) a score of ≥ 40 on the State-Trait Anxiety Inventory State and/or a score of ≥ 6 on the EPDS - anxiety subscale. Logistic regression analyses were used to identify socio-demographic, obstetrics, and mental health risk factors of CAD. RESULTS The prevalence of CAD was 6.8%. Age between 30 and 35 years (OR=3.01, 95% CI: 1.22-7.45) compared to younger age, current sleep disorders (OR=7.88, 95% CI: 3.83-16.23), and preconception mood disorders (OR=2.76, 95% CI: 1.31-5.84) were associated with higher odds of CAD. Conversely, the presence of no or few economic problems (OR=0.21, 95% CI: 0.07-0.65; OR=0.26, 95% CI: 0.09-0.77) and the perception of enough or more than enough practical support from friends or relatives (OR=0.32, 95% CI: 0.13-0.80; OR=0.22, 95% CI: 0.09-0.53) were associated with lower odds of developing CAD. LIMITATIONS The cross-sectional design; the use of self-report questionnaires. CONCLUSION CAD is relatively common among third-trimester antepartum women. The provision of economic/practical support may reduce CAD prevalence and its direct and indirect costs.
Collapse
Affiliation(s)
- Loredana Cena
- Observatory of Perinatal Clinical Psychology, Department of Clinical and Experimental Sciences, Section of Neuroscience, University of Brescia, viale Europa 11, 25123 Brescia, Italy.
| | - Antonella Gigantesco
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Fiorino Mirabella
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Gabriella Palumbo
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Laura Camoni
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Alice Trainini
- Observatory of Perinatal Clinical Psychology, Department of Clinical and Experimental Sciences, Section of Neuroscience, University of Brescia, viale Europa 11, 25123 Brescia, Italy
| | - Alberto Stefana
- Observatory of Perinatal Clinical Psychology, Department of Clinical and Experimental Sciences, Section of Neuroscience, University of Brescia, viale Europa 11, 25123 Brescia, Italy
| |
Collapse
|
25
|
Letter to the editor on: “The unheard parental cry of a stillbirth: fathers and mothers”. Arch Gynecol Obstet 2021; 306:563. [PMID: 34727224 PMCID: PMC8562375 DOI: 10.1007/s00404-021-06249-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/09/2021] [Indexed: 11/09/2022]
|
26
|
Jain D, Jain AK, Metz GAS, Ballanyi N, Sood A, Linder R, Olson DM. A Strategic Program for Risk Assessment and Intervention to Mitigate Environmental Stressor-Related Adverse Pregnancy Outcomes in the Indian Population. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:673118. [PMID: 36304060 PMCID: PMC9580833 DOI: 10.3389/frph.2021.673118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
The Problem: Global environmental stressors of human health include, but are not limited to, conflict, migration, war, natural disasters, climate change, pollution, trauma, and pandemics. In combination with other factors, these stressors influence physical and mental as well as reproductive health. Maternal stress is a known factor for adverse pregnancy outcomes such as preterm birth (PTB); however, environmental stressors are less well-understood in this context and the problem is relatively under-researched. According to the WHO, major Indian cities including New Delhi are among the world's 20 most polluted cities. It is known that maternal exposure to environmental pollution increases the risk of premature births and other adverse pregnancy outcomes which is evident in this population. Response to the Problem: Considering the seriousness of this problem, an international and interdisciplinary group of researchers, physicians, and organizations dedicated to the welfare of women at risk of adverse pregnancy outcomes launched an international program named Optimal Pregnancy Environment Risk Assessment (OPERA). The program aims to discover and disseminate inexpensive, accessible tools to diagnose women at risk for PTB and other adverse pregnancy outcomes due to risky environmental factors as early as possible and to promote effective interventions to mitigate these risks. OPERA has been supported by the Worldwide Universities Network, World Health Organization (WHO) and March of Dimes USA. Addressing the Problem: This review article addresses the influence of environmental stressors on maternal-fetal health focusing on India as a model population and describes the role of OPERA in helping local practitioners by sharing with them the latest risk prediction and mitigation tools. The consequences of these environmental stressors can be partially mitigated by experience-based interventions that build resilience and break the cycle of inter- and-transgenerational transmission. The shared knowledge and experience from this collaboration are intended to guide and facilitate efforts at the local level in India and other LMIC to develop strategies appropriate for the jurisdiction for improving pregnancy outcomes in vulnerable populations.
Collapse
Affiliation(s)
- Divyanu Jain
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
- *Correspondence: Divyanu Jain
| | - Ajay K. Jain
- Department of Obstetrics & Gynecology and In-vitro Fertilization Center, Jaipur Golden Hospital, New Delhi, India
- IVF Center, Muzaffarnagar Medical College, Muzaffarnagar, India
| | - Gerlinde A. S. Metz
- Department of Neuroscience, University of Lethbridge, Lethbridge, AB, Canada
| | - Nina Ballanyi
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | - Abha Sood
- Department of Obstetrics & Gynecology and In-vitro Fertilization Center, Jaipur Golden Hospital, New Delhi, India
| | - Rupert Linder
- Specialist for Gynecology, Obstetrics, Psychosomatics and Psychotherapy, Birkenfeld, Germany
| | - David M. Olson
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
- Departments of Pediatrics and Physiology, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
27
|
Tuovinen S, Lahti-Pulkkinen M, Girchenko P, Heinonen K, Lahti J, Reynolds RM, Hämäläinen E, Villa PM, Kajantie E, Laivuori H, Raikkonen K. Maternal antenatal stress and mental and behavioral disorders in their children. J Affect Disord 2021; 278:57-65. [PMID: 32950844 DOI: 10.1016/j.jad.2020.09.063] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Maternal antenatal stress, including symptoms of depression, anxiety and perceived stress, is associated with mental and behavioral problems in children. Whether it is associated with child mental and behavioral disorders remains uncertain. We examined if maternal antenatal symptoms of depression, anxiety and perceived stress were associated with mental and behavioral disorders in their children, if the associations varied according to gestational week, stress type, fluctuating or consistently high symptoms, and if they were driven by maternal or paternal lifetime mood or anxiety disorders. METHODS 3365 mothers participating in the Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction (PREDO) study completed the Center for Epidemiologic Studies Depression Scale, the State Anxiety Inventory and the Perceived Stress Scale up to 14 times throughout pregnancy. The Care Register for Health Care provided data on mental and behavioral (including neurodevelopmental) disorders for their children from birth (11/07/2006-07/24/2010) until 12/31/2016 and for parental lifetime mood and anxiety disorders until 12/31/2016. RESULTS The hazard of any childhood mental and behavioral disorder (HR=1.91, 95% CI: 1.39-2.51) was significantly higher for children whose mothers reported consistently high in comparison to consistently low levels of all types of stress throughout pregnancy. The associations remained significant when adjusted for maternal and paternal lifetime mood and anxiety disorders (and their comorbidity and timing and mood disorder type). CONCLUSION Maternal antenatal stress is associated with higher risk of childhood mental and behavioral disorders. Efforts to reduce maternal antenatal stress should be given a high priority to improve child mental health.
Collapse
Affiliation(s)
- Soile Tuovinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland.
| | - Marius Lahti-Pulkkinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Polina Girchenko
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Kati Heinonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Jari Lahti
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Rebecca M Reynolds
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Esa Hämäläinen
- Department of Clinical Chemistry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pia M Villa
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eero Kajantie
- National Institute for Health and Welfare, Helsinki, Finland; PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Clinical and Molecular Medicine, Norwegian University for Science and Technology, Trondheim, Norway
| | - Hannele Laivuori
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland; Department of Obstetrics and Gynecology, Tampere University Hospital and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Katri Raikkonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| |
Collapse
|
28
|
Kristoffersen ES, Børte S, Hagen K, Zwart JA, Winsvold BS. Caesarean section and the association with migraine: a retrospective register-linked HUNT population cohort study. BMJ Open 2020; 10:e040685. [PMID: 33208331 PMCID: PMC7677333 DOI: 10.1136/bmjopen-2020-040685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To evaluate the association between caesarean section and migraine in a population-based register-linked cohort study. SETTING Data from the population-based Nord-Trøndelag Health Studies (HUNT2 and HUNT3) were linked to information from the Norwegian Medical Birth Registry. PARTICIPANTS 65 343 participants responded to the headache questions in any of the two HUNT studies. Only those answering the headache questions in HUNT2 or 3 and had information about mode of delivery in the Norwegian Medical Birth Registry (born after 1967) were included. Our final sample consisted of 6592 women and 4602 men, aged 19-41 years. OUTCOMES ORs for migraine given caesarean section. Analyses were performed in multivariate logistic regression models. RESULTS After adjusting for sex, age and fetal growth restriction, delivery by caesarean section was not associated with migraine later in life (OR 0.86, 95% CI 0.64 to 1.15). Delivery by caesarean section was associated with a reduced OR of non-migrainous headache (OR 0.77, 95% CI 0.60 to 0.99). CONCLUSION No association was found between caesarean section and migraine in this population-based register-linked study.
Collapse
Affiliation(s)
- Espen Saxhaug Kristoffersen
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Sigrid Børte
- Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Knut Hagen
- Department of Neuromedicine and Movement science, Norwegian University of Science and Technology, Trondheim, Norway
- Clinical Research Unit Central Norway, St. Olavs University Hospital, Trondheim, Norway
| | - John-Anker Zwart
- Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Bendik Slagsvold Winsvold
- Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
29
|
Müller M, Matthies LM, Goetz M, Abele H, Brucker SY, Bauer A, Graf J, Zipfel S, Hasemann L, Wallwiener M, Wallwiener S. Effectiveness and cost-effectiveness of an electronic mindfulness-based intervention (eMBI) on maternal mental health during pregnancy: the mindmom study protocol for a randomized controlled clinical trial. Trials 2020; 21:933. [PMID: 33203471 PMCID: PMC7672841 DOI: 10.1186/s13063-020-04873-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 11/04/2020] [Indexed: 01/21/2023] Open
Abstract
Background Mental disorders are common during the peripartum period and may have far-reaching consequences for both mother and child. Unfortunately, most antenatal care systems do not provide any structured screening for maternal mental health. As a consequence, mental illnesses are often overlooked and not treated adequately. If correctly diagnosed, cognitive behavioral therapy is currently the treatment of choice for mental illnesses. In addition, mindfulness-based interventions (MBIs) seem to represent a promising treatment option for anxiety and depression during the peripartum period. Considering the internet’s increasing omnipresence, MBIs can also be offered electronically via a (tablet) computer or smartphone (electronically based MBI = eMBI). Objective The current study aims to examine the clinical effectiveness and cost-effectiveness of an eMBI (the mindmom application) developed by an interdisciplinary team of gynecologists, psychologists, and midwives, teaching pregnant women how to deal with stress, pregnancy-related anxiety, and depressive symptoms. The study sample consists of pregnant women in their third trimester who screened positive for emotional distress. The mindmom study is a bicentric prospective randomized controlled trial (RCT), which is currently conducted at the University women’s hospitals of Heidelberg and Tübingen, Germany. Methods Within the scope of the routine prenatal care, pregnant women attending routine pregnancy care in Baden-Wuerttemberg, Germany, are invited to participate in a screening for mental distress based on the Edinburgh Postnatal Depression Scale (EPDS). Women with an EPDS screening result > 9 will be referred to one of the mindmom coordinating study centers and are offered counseling either face-to-face or via videotelephony. After an initial psychological counseling, women are invited to participate in an eMBI in their last pregnancy trimester. The study will enroll N = 280 study participants (N = 140 per group), who are randomized 1:1 into the intervention (IG) or control group (treatment as usual = TAU). All participants are requested to complete a total of 7 digital assessments (5 visits pre- and 2 follow-up visits postpartum), involving self-report questionnaires, sociodemographic and medical data, physiological measures, and morning cortisol profiles. The primary outcome will be depressive and anxiety symptoms, measured by the Edinburgh Postnatal Depression Scale, the State Trait Anxiety Questionnaire, and the Pregnancy-Related Anxiety Questionnaire. Secondary outcomes include mindfulness, satisfaction with birth, quality of life, fetal attachment, bonding, mode of delivery, and cost-effectiveness. Discussion This is the first German RCT to examine the (cost-)effectiveness of an eMBI on maternal mental health during pregnancy. If successful, the mindmom app represents a low-threshold and cost-effective help for psychologically distressed women during pregnancy, thereby reducing the negative impact on perinatal health outcome. Trial registration Deutsches Register Klinischer Studien, German Clinical Trials Register DRKS00017210. Registered on 13 January 2020. Retrospectively registered. Supplementary information The online version contains supplementary material available at 10.1186/s13063-020-04873-3.
Collapse
Affiliation(s)
- Mitho Müller
- Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Maren Goetz
- Universitätsklinikum Heidelberg Zentrum für Kinder und Jugendmedizin, Heidelberg, Germany
| | - Harald Abele
- Universitäts-Frauenklinik Tübingen, Tübingen, Germany
| | | | - Armin Bauer
- Institute for Women's Health Tübingen, Tübingen, Germany
| | - Johanna Graf
- Universitätsklinikum Tübingen Medizinische Universitätsklinik, Tübingen, Germany
| | - Stephan Zipfel
- Universitätsklinikum Tübingen Medizinische Universitätsklinik, Tübingen, Germany
| | | | | | | |
Collapse
|
30
|
Mirzakhani K, Khadivzadeh T, Faridhosseini F, Ebadi A. Pregnant Women's Experiences of the Conditions Affecting Marital Well-Being in High-Risk Pregnancy: A Qualitative Study. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2020; 8:345-357. [PMID: 33178857 PMCID: PMC7648861 DOI: 10.30476/ijcbnm.2020.85666.1285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/25/2020] [Accepted: 07/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND High-risk pregnancy is associated with many problems which can affect marital well-being as well as maternal and fetal health. Yet, there is limited information about the conditions which affect marital well-being in high-risk pregnancy. This study aimed to explore the pregnant women's experiences of the conditions affecting marital well-being in high-risk pregnancy. METHODS This qualitative study was conducted from October 2018 to December 2019. Participants were 24 women with high-risk pregnancy who were purposively selected from three public and two private hospitals as well as a primary healthcare center in Mashhad, Iran. Face-to-face semi-structured interviews were conducted for data collection. Data were analyzed concurrently with data collection through Graneheim and Lundman's content analysis (2004). The MAXQDA program (v. 10) was used for data management. RESULTS Conditions affecting marital well-being in high-risk pregnancy were categorized into eleven subcategories and three main categories, namely emotional spousal intimacy in the midst of danger, husband's commitment to manage the difficult conditions of pregnancy and sexual relationship during high-risk pregnancy. CONCLUSION Several conditions can affect marital well-being in high-risk pregnancy. Healthcare providers can develop and use strategies for the effective management of these conditions, thereby improving marital well-being among women with high-risk pregnancy.
Collapse
Affiliation(s)
- Kobra Mirzakhani
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Talaat Khadivzadeh
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farhad Faridhosseini
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life style institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Department of Nursing Management, Baqiyatallah University of Medical Sciences, Tehran, Iran
| |
Collapse
|
31
|
Goetz M, Schiele C, Müller M, Matthies LM, Deutsch TM, Spano C, Graf J, Zipfel S, Bauer A, Brucker SY, Wallwiener M, Wallwiener S. Effects of a Brief Electronic Mindfulness-Based Intervention on Relieving Prenatal Depression and Anxiety in Hospitalized High-Risk Pregnant Women: Exploratory Pilot Study. J Med Internet Res 2020; 22:e17593. [PMID: 32780023 PMCID: PMC7448174 DOI: 10.2196/17593] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/03/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023] Open
Abstract
Background Peripartum depression and anxiety disorders are highly prevalent and are correlated with adverse maternal and neonatal outcomes. Antenatal care in Germany does not yet include structured screening and effective low-threshold treatment options for women facing peripartum depression and anxiety disorders. Mindfulness-based interventions (MBIs) are increasingly becoming a focus of interest for the management of such patients. Studies have shown a decrease in pregnancy-related stress and anxiety in expectant mothers following mindfulness programs. Objective The aim of this study was to explore the clinical effectiveness of a 1-week electronic course of mindfulness on prenatal depression and anxiety in hospitalized, high-risk pregnant women. We hypothesized that participating in a 1-week electronic MBI (eMBI) could alleviate symptoms of depression and anxiety during the hospital stay. Methods A prospective pilot study with an explorative study design was conducted from January to May 2019 in a sample of 68 women hospitalized due to high-risk pregnancies. After enrolling into the study, the participants were given access to an eMBI app on how to deal with stress, anxiety, and symptoms of depression. Psychometric parameters were assessed via electronic questionnaires comprising the Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI-S), and abridged version of the Pregnancy-Related Anxiety Questionnaire (PRAQ-R). Results We observed a high prevalence of peripartum depression and anxiety among hospitalized high-risk pregnant women: 39% (26/67) of the study participants in the first assessment and 41% (16/39) of the participants in the second assessment achieved EPDS scores above the cutoff value for minor/major depression. The number of participants with anxiety levels above the cutoff value (66% [45/68] of the participants in the first assessment and 67% [26/39] of the participants in the second assessment) was significantly more than that of the participants with anxiety levels below the cutoff value, as measured with the STAI-S. After completing the 1-week electronic course on mindfulness, the participants showed a significant reduction in the mean state anxiety levels (P<.03). Regarding pregnancy-related anxiety, participants who completed more than 50% of the 1-week course showed lower scores in PRAQ-R in the second assessment (P<.05). No significant changes in the EPDS scores were found after completing the intervention. Conclusions Peripartum anxiety and depression represent a relevant health issue in hospitalized pregnant patients. Short-term eMBIs could have the potential to reduce anxiety levels and pregnancy-related anxiety. However, we observed that compliance to eMBI seems to be related to lower symptoms of pregnancy-related stress among high-risk patients. eMBIs represent accessible mental health resources at reduced costs and can be adapted for hospitalized patients during pregnancy.
Collapse
Affiliation(s)
- Maren Goetz
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany.,Department of General Pediatrics, University Children's Hospital, Heidelberg, Germany
| | - Claudia Schiele
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Mitho Müller
- Department of Psychology, Ludwig Maximilian University, Munich, Germany
| | - Lina M Matthies
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Thomas M Deutsch
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Claudio Spano
- Department of Psychology, Ludwig Maximilian University, Munich, Germany
| | - Johanna Graf
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Armin Bauer
- Research Institute for Women's Health, Department of Women's Health, University Hospital Tuebingen, Tuebingen, Germany
| | - Sara Y Brucker
- Department of Women's Health, University Hospital Tuebingen, Tuebingen, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Stephanie Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
32
|
Schramm K, Nees J, Hoffmann J, Bruckner T, Haun MW, Maatouk I, Stepan H, Schott S. Emergency consultations in obstetrics: identification of decisive, contributing and associated factors. Arch Gynecol Obstet 2020; 302:821-828. [PMID: 32607806 DOI: 10.1007/s00404-020-05662-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/18/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Psychosocial and biological factors influence the perception of physical changes during pregnancy. Some pregnant women present to the obstetric emergency department (ED) with diverse symptoms not requiring urgent medical action. These visits result in over-consultation, tying up resources and inflating health care expenses. This study outlines factors associated with multiple ED visits during pregnancy, measures the prevalence of anxiety and depression, and explores the choice of maternity clinic for delivery aiming to elucidate options for care strategies. METHODS This prospective, cross-sectional, questionnaire-based bicentric study was performed in the obstetric outpatient departments of two university hospitals in Germany and recruited pregnant women between 12/2016 and 11/2017. The questionnaire included socio-demographics, obstetric history, anxiety (GAD-7), depression (PHQ-9), and health status (WHO-5, SF-12). RESULTS This analysis included 496 women and showed that women with numerous ED visits were significantly younger (p < 0.0001), less educated (p = 0.0002), and more likely to be unemployed and single. Different prevalences for anxiety and depression were detected correlating with the number of ED visits although each showing only low effect sizes (0.024 resp. 0.015). CONCLUSIONS Pregnant women attending the ED more often might benefit from health education, psychosomatic interventions, and social support to overcome their depression and anxiety to avoid non-urgent ED consultations. Further prospective studies are needed to support these findings.
Collapse
Affiliation(s)
- Katharina Schramm
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.,Children's Hospital Heilbronn, SLK-Klinikum am Gesundbrunnen, Heilbronn, Germany
| | - Juliane Nees
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
| | - Janine Hoffmann
- Department of Obstetrics, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Markus W Haun
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Imad Maatouk
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Holger Stepan
- Department of Obstetrics, University Hospital Leipzig, Leipzig, Germany
| | - Sarah Schott
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| |
Collapse
|
33
|
Kaźmierczak M, Gebuza G, Gierszewska M, Bannach M, Mieczkowska E, Dombrowska-Pali A, Czubkowska M. Screening for Detection of the Risk of Perinatal Mental Disorders among Women in Poland. Issues Ment Health Nurs 2020; 41:438-444. [PMID: 32202956 DOI: 10.1080/01612840.2019.1677829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of the study was to assess the severity of depressive symptoms, to analyze risk factors for perinatal mental disorders and to assess dispositional optimism. A total of 106 women from Poland were included in the study at 37-week pregnant and 6 weeks after giving birth. It was demonstrated that the main predictors of perinatal mental disorders were the variables: mental health disorders before pregnancy, subjectively reported decreased mood in pregnancy, the lack of social (instrumental) support and the tendency to pessimism. The results of the study suggest how important it is to introduce clinical practice in Poland to screen for early detection of the risk of depression during pregnancy and postpartum depression.
Collapse
Affiliation(s)
| | - Grażyna Gebuza
- Faculty of Health Sciences, Nicolaus Copernicus University in Torun, Poland
| | | | - Małgorzata Bannach
- Faculty of Health Sciences, Nicolaus Copernicus University in Torun, Poland
| | - Estera Mieczkowska
- Faculty of Health Sciences, Nicolaus Copernicus University in Torun, Poland
| | | | - Martyna Czubkowska
- Faculty of Health Sciences, Nicolaus Copernicus University in Torun, Poland
| |
Collapse
|
34
|
Herbell K, Zauszniewski JA, Williams E. Stress and Depressive Symptoms Among Demographically Diverse American Pregnant Women. Issues Ment Health Nurs 2020; 41:73-82. [PMID: 31770053 DOI: 10.1080/01612840.2019.1662145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Pregnancy is a sensitive period of life where mental health is of utmost importance to the mother's and child's well-being peripartum and beyond. To better prevent and treat common mental health conditions such as depressive symptoms and perceived stress (defined in this study to encompass psychological and physiological (heart rate variability (HRV)) dimensions), it is crucial to examine and report differences in mental health outcomes among demographically diverse pregnant women. Therefore, the purpose of this secondary analysis (N = 79) was to determine if there are differences in mental health outcomes between pregnant women who differ across demographic factors, as well as to determine if demographic factors predict mental health outcomes when controlling for other demographic variables. Findings indicate that there were significant differences in depressive symptoms and perceived stress by all demographic factors except age. Marital status and total household income were the only significant predictors of depressive symptoms and perceived stress, respectively, when all other factors were controlled. There were no significant differences or correlations between demographic variables and HRV. Pregnant women may be predisposed to adverse mental health outcomes, illustrating the need for more refined interventions that are sensitive to pre-existing factors.
Collapse
Affiliation(s)
| | - Jaclene A Zauszniewski
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
| | - Elizabeth Williams
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
| |
Collapse
|
35
|
Bischoff M, Howland V, Klinger-König J, Tomczyk S, Schmidt S, Zygmunt M, Heckmann M, van den Berg N, Bethke B, Corleis J, Günther S, Liutkus K, Stentzel U, Neumann A, Penndorf P, Ludwig T, Hammer E, Winter T, Grabe HJ. Save the children by treating their mothers (PriVileG-M-study) - study protocol: a sequentially randomized controlled trial of individualized psychotherapy and telemedicine to reduce mental stress in pregnant women and young mothers and to improve Child's health. BMC Psychiatry 2019; 19:371. [PMID: 31775668 PMCID: PMC6880484 DOI: 10.1186/s12888-019-2279-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/10/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND As early as pregnancy, maternal mental stress impinges on the child's development and health. Thus, this may cause enhanced risk for premature birth, lowered fetal growth, and lower fetal birth weight as well as enhanced levels of the stress hormone cortisol and lowered levels of the bonding hormone oxytocin. Maternal stress further reduces maternal sensitivity for the child's needs which impairs the mother-child-interaction and bonding. Therefore, prevention and intervention studies on mental stress are necessary, beginning prenatally and applying rigorous research methodology, such as randomized controlled trials, to ensure high validity. METHODS A randomized controlled trial is used to assess the impact of psychotherapy and telemedicine on maternal mental stress and the child's mental and physical health. Mentally stressed pregnant women are randomized to an intervention (IG) and a not intervened control group. The IG receives an individualized psychotherapy starting prenatal and lasting for 10 months. Afterwards, a second randomization is used to investigate whether the use of telemedicine can stabilize the therapeutic effects. Using ecological momentary assessments and video recordings, the transfer into daily life, maternal sensitivity and mother-child-bonding are assessed. Psycho-biologically, the synchronicity of cortisol and oxytocin levels between mother and child are assessed as well as the peptidome of the colostrum and breast milk, which are assumed to be essential for the adaptation to the extra-uterine environment. All assessments are compared to an additional control group of healthy women. Finally, the results of the study will lead to the development of a qualification measure for health professionals to detect mental stress, to treat it with low-level interventions and to refer those women with high stress levels to mental health professionals. DISCUSSION The study aims to prevent the transgenerational transfer of psychiatric and somatic disorders from the mother to her child. The effects of the psychotherapy will be stabilized through telemedicine and long-term impacts on the child's and mothers' mental health are enhanced. The combination of psychotherapy, telemedicine and methodologies of ecological momentary assessment, video recording and bio banking are new in content-related and methodological manner. TRIAL REGISTRATION German Clinical Trials Register: DRKS00017065. Registered 02 May 2019. World Health Organization, Universal Trial Number: U1111-1230-9826. Registered 01 April 2019.
Collapse
Affiliation(s)
- M. Bischoff
- Department of Health and Prevention, Institute of Psychology, University Greifswald, Greifswald, Germany
| | - V. Howland
- Department of Neonatology and Paediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany
| | - J. Klinger-König
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - S. Tomczyk
- Department of Health and Prevention, Institute of Psychology, University Greifswald, Greifswald, Germany
| | - S. Schmidt
- Department of Health and Prevention, Institute of Psychology, University Greifswald, Greifswald, Germany
| | - M. Zygmunt
- Clinic and Polyclinic for Obstetrics and Gynecology, University Medicine Greifswald, Greifswald, Germany
| | - M. Heckmann
- Department of Neonatology and Paediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany
| | - N. van den Berg
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - B. Bethke
- Department of Health, Nursing and Administration, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - J. Corleis
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - S. Günther
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - K. Liutkus
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - U. Stentzel
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - A. Neumann
- Department of Health, Nursing and Administration, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - P. Penndorf
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - T. Ludwig
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - E. Hammer
- Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - T. Winter
- Integrated Research Biobank, University Medicine Greifswald, Greifswald, Germany
| | - H. J. Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| |
Collapse
|
36
|
Ellman LM, Murphy SK, Maxwell SD, Calvo EM, Cooper T, Schaefer CA, Bresnahan MA, Susser ES, Brown AS. Maternal cortisol during pregnancy and offspring schizophrenia: Influence of fetal sex and timing of exposure. Schizophr Res 2019; 213:15-22. [PMID: 31345704 PMCID: PMC7074891 DOI: 10.1016/j.schres.2019.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 06/28/2019] [Accepted: 07/02/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Maternal stress during pregnancy has been repeatedly linked to increased risk for schizophrenia; however, no study has examined maternal cortisol during pregnancy and risk for the disorder. Study aims were to determine whether prenatal cortisol was associated with risk for schizophrenia and risk for an intermediate phenotype-decreased fetal growth-previously linked to prenatal cortisol and schizophrenia. Timing of exposure and fetal sex also were examined given previous findings. METHODS Participants were 64 cases diagnosed with schizophrenia spectrum disorders (SSD) and 117 controls from a prospective birth cohort study. Maternal cortisol was determined from stored sera from each trimester and psychiatric diagnoses were assessed from offspring using semi-structured interviews and medical records review. RESULTS Maternal cortisol during pregnancy was not associated with risk for offspring schizophrenia. There was a significant interaction between 3rd trimester cortisol and case status on fetal growth. Specifically, cases exposed to higher 3rd trimester maternal cortisol had significantly decreased fetal growth compared to controls. In addition, these findings were restricted to male offspring. CONCLUSIONS Our results indicate that higher prenatal cortisol is associated with an intermediate phenotype linked to schizophrenia, fetal growth, but only among male offspring who developed schizophrenia. Findings were consistent with evidence that schizophrenia genes may disrupt placental functioning specifically for male fetuses, as well as findings that males are more vulnerable to maternal cortisol during pregnancy. Finally, results suggest that examining fetal sex and intermediate phenotypes may be important in understanding the mechanisms involved in prenatal contributors to schizophrenia.
Collapse
Affiliation(s)
- Lauren M Ellman
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13(th) Street, Philadelphia, PA 19106, United States of America.
| | - Shannon K Murphy
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13(th) Street, Philadelphia, PA 19106, United States of America.
| | - Seth D Maxwell
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13(th) Street, Philadelphia, PA 19106, United States of America.
| | - Evan M Calvo
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13(th) Street, Philadelphia, PA 19106, United States of America.
| | - Thomas Cooper
- Analytic Psychopharmacology, Nathan S. Kline Institute, 140 Old Orangeburg Road Orangeburg, NY 10962, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America; Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Catherine A Schaefer
- Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, United States of America.
| | - Michaeline A Bresnahan
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168(th) Street, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Ezra S Susser
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168(th) Street, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Alan S Brown
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168(th) Street, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America; Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States of America.
| |
Collapse
|