Perinatal depressive symptomatology among lesbian and bisexual women

The effects of flavonoid supplementation on the mental health of postpartum parents

Introduction

During the postpartum period, parents face psychological challenges and consequently, changes in mood and associated mood disorders have become increasingly prevalent in the 6-months following birth. Dietary flavonoids have been found to benefit mood and are therefore an appealing non-pharmacological option for potentially treating mood disorders in the postpartum. The aim of this study was to investigate whether a two-week dietary flavonoid intervention would improve mothers' and fathers' mental health in the immediate 6-month postpartum period.

Method

The study employed a randomised, parallel groups, controlled design to explore the effects of a flavonoid intervention vs. control group on several outcomes, including mood (PANAS), postpartum depression (EPDS), postpartum anxiety (PSAS-RSF-C) and quality of life (WHOQOL). Sixty participants (mothers n = 40, fathers n = 20) in the 6-month post-partum period were randomised to either a "flavonoid" or "control" condition. The flavonoid group were asked to add two flavonoid-rich foods (approximate flavonoid intake 218 mg/day) into their daily diet whilst controls (n = 23) were asked to continue with their usual diet for two-weeks (ClinicalTrials.gov (NCT04990622).

Results

Significant effects were found in the flavonoid group where mothers reported higher positive affect and lower postpartum depression after the two-week intervention relative to baseline. This finding is especially relevant as a clinical reduction in postpartum depression scores in the flavonoid group by an average 2.6 scoring points was observed, which equated to a reduction from "possible depression" at baseline to "little or no depression" at 2-weeks, which was not observed in the control group. Fathers' data was not analysed due to non-compliance with the intervention.

Discussion

This study provides evidence for the benefits of a dietary flavonoid intervention for mood and mental health in new mothers, supporting the utility of non-pharmacological, self-administrable changes to the diet for improving positive mood outcomes and reducing symptoms of postpartum depression in mothers during an especially challenging time. Further research for the effect of dietary interventions on paternal mental health is needed.

Clinical Trial Registration

ClinicalTrials.gov, identifier NCT04990622.

Perinatal Depression Screening Among Sexual Minority Women

Importance

A substantial number of births in the US are to sexual minority women (17% based on a nationally representative survey), yet there is little research on perinatal depression screening rates or symptom endorsement among sexual minority women (including women who identify as lesbian, bisexual, queer, pansexual, asexual, demisexual, and kinky as well as other-identified women who have sex with women). High rates of risk factors for perinatal depression (eg, intimate partner violence and history of mental illness) among sexual minority individuals magnify this gap in the literature.

Objective

To describe the prevalence of female-identified sexual minority people giving birth in an academic medical center and compare perinatal depression screening rates and scores among sexual minority women and heterosexual cisgender women.

Design, Setting, and Participants

This retrospective cohort study used deidentified medical record review of 18 243 female-identified individuals who gave birth at an academic medical center in Chicago, Illinois, between January 1 and December 31, 2019. Data were analyzed from April 5, 2021, to August 1, 2022.

Main Outcomes and Measures

Proportion of women identified as having sexual minority status in the medical record, rates of standard care administration of the 9-item Patient Health Questionnaire between sexual minority women and heterosexual women, and depression screening scores and rates of positive depression screening results for sexual minority and heterosexual women.

Results

Among 18 243 women (mean [SD] age, 33.8 [5.1] years; 10 453 [57.3%] of non-Hispanic White race and ethnicity), only 280 (1.5%; 95% CI, 1.3%-1.7%) were identified as having sexual minority status in the medical record. Significantly more sexual minority women vs heterosexual women attended at least 1 prenatal care visit (56 [20.0%] vs 2459 [13.7%]; P = .002) and at least 1 postpartum care visit (52 [18.6%] vs 2304 [12.8%]; P = .004). Sexual minority women were more likely to be screened for depression during postpartum care (odds ratio, 1.77; 95% CI, 1.22-2.52; P = .002) and more likely to screen positive for depression during the postpartum period (odds ratio, 2.38; 95% CI, 0.99-5.02; P = .03) than heterosexual women.

Conclusions and Relevance

In this cohort study, sexual minority women identified in the medical record were highly engaged in obstetric care yet at high risk of postpartum depression. In addition, their sexual orientation was largely undocumented in medical records. These results highlight the need for investigations that include strategies for measuring sexual orientation because medical record review is unlikely to reliably capture these sexual identities during the perinatal period.

Lesbian couples’ childbearing experiences using assisted reproductive technology: A netnography study

OBJECTIVE

This study aimed to explore how Chinese lesbian couples perceived having children through assisted reproductive technology (ART) and its impact on their experiences of family formation.

DESIGN

This study adopted netnography to investigate online forum data created by self-identified lesbian couples in relation to assisted reproduction. Summative content analysis was used to analyse data.

FINDINGS

Based on data analysis, A luan B huai, in which a lesbian conceives a child using her partner's egg, was seen as the best way to establish a family because it created a sense of symbolic connectedness with the child for both of them. Moreover, lesbian couples also indicated the crucial role that having children plays in maintaining family harmony, despite their opposition to heterosexual family traditions. With the stratification of reproductive tourism, certain groups of lesbians for instance, those with limited social and cultural capital- might be at a disadvantage in the global setting of reproductive tourism.

CONCLUSIONS AND IMPLICATIONS

Lesbian couples valued the benefits of ART in assisting them to achieve their childbearing goals and build a family. Healthcare providers should take the initiative to enhance fertility care by addressing the concerns and unique challenges faced by lesbian populations.

Non-birthing mothers' experiences of perinatal anxiety and depression: Understanding the perspectives of the non-birthing mothers in female same-sex parented families

OBJECTIVE

Partners of birthing mothers can themselves experience perinatal mental health (PMH) difficulties. Despite birth rates increasing amongst LGBTQIA+ communities and the significant impact of PMH difficulties, this area is under-researched. This study aimed to examine the experiences of perinatal depression and anxiety of non-birthing mothers in female same-sex parented families.

DESIGN

Interpretative Phenomenological Analysis (IPA) was used to explore the experiences of non-birthing mothers who self-identified as having experienced perinatal anxiety and/or depression.

SETTING AND PARTICIPANTS

Sevenparticipants were recruited from online and local voluntary and support networks for LGBTQIA+ communities and for PMH. Interviews were in-person, online or via telephone.

MEASUREMENTS AND FINDINGS

Six themes were generated. Distress was characterised by feelings of "Failure and Inadequacy in Role" (i.e., parent, partner and individual) and "Powerlessness and Intolerable Uncertainty" in their parenting journey. These feelings were reciprocally influenced by perceptions of the "Legitimacy of (Di)stress as a Non-birthing Parent", which impacted help-seeking. Stressors that contributed to these experiences were: "Parenting Without" a parental role template, social recognition and safety, and parental connectedness; and "Changed Relationship Dynamics" with their partner. Finally,participants spoke about "Moving Forward" in their lives.

KEY CONCLUSIONS

Some findings are consistent with the literature on paternal mental health, including parents' emphasis on protecting their family and experiencing services as focusing on the birthing parent. Others appeared distinct or amplified for LGBTQIA+ parents, including the lack of a defined and socially recognised role; stigma concerning both mental health and homophobia; exclusion from heteronormative healthcare systems; and the importance placed on biological connectedness.

IMPLICATIONS FOR PRACTICE

Culturally competent care is needed to tackle minority stress and recognise diverse family forms.

Childbearing at the margins: A systematic metasynthesis of sexual and gender diverse childbearing experiences

BACKGROUND

The reproductive and perinatal health of sexual and gender-diverse (SGD) individuals is a research priority area for the National Institutes of Health. Over the past decade, this childbearing population has been the focus of several qualitative studies providing the opportunity to evaluate and synthesize the qualitative literature on SGD childbearing experiences in a metasynthesis.

METHODS

We conducted a literature search of four databases to identify original research published from January 2011 through June 2021. These results were augmented by forward and backward searching strategies. Two authors independently screened studies. All qualitative studies of the childbearing experience were eligible. Data were extracted and inductively coded using conventional content analysis, and studies underwent a quality appraisal by two authors.

RESULTS

From 2396 articles, 127 full-text articles were screened, and 25 were included in this synthesis. Three overarching themes were identified: (a) Systematic Invisibility; (b) Creating Personhood Through Parenthood; and (c) Resilient Narratives of Childbearing.

CONCLUSIONS

Relative to heterosexual and cisgender parents, SGD childbearing parents experience unique structural and interpersonal challenges and employ critically important resilience strategies and coping techniques to manage an overwhelming heterocisnormative experience. These findings provide an important target for health care organizations and professionals to improve SGD perinatal health. In addition, this metasynthesis identified persistent gaps in our understanding of this marginalized childbearing population, which have important implications for reducing health disparities that SGD parents experience.

Postpartum Depression Among Gay Fathers With Children Born Through Surrogacy: A Cross-sectional Study

BACKGROUND

Studies on postpartum depression (PPD) in gay fathers are scarce. The goals of this study were to examine the prevalence of PPD among Israeli gay fathers with children born through surrogacy and to identify characteristics associated with PPD in this population.

METHODS

In this descriptive cross-sectional study, we sent surveys to gay fathers who had children who were 0 to 12 months of age and were born through surrogacy. Surveys were sent through 3 major surrogacy agencies in Israel and through the media. Data were collected concerning sociodemographic, medical, and lifestyle factors as well as concerning satisfaction with partners, family, and social support. Each respondent completed the Edinburgh Postnatal Depression Scale, which screens for PPD. Characteristics of fathers with and without probable PPD were compared.

RESULTS

Between July 2018 and December 2019, 66 men answered our questionnaire. The respondents, mean age of 37.5 years, were mostly first-time fathers (82%), with high rates of twin pregnancies (42%). Eight respondents (12%) were classified as having depressive symptoms (95% CI: 5.4%-22.5%), and 16 respondents (25%) reported current or past use of antidepressant medications. A negative association was observed between satisfaction with family support and report of depressive symptoms (χ22=6.53, P=0.038) and Spearman correlation test (rs=-0.34, P=0.005).

CONCLUSIONS

The incidence of probable PPD among gay fathers was 12% compared with 8.8% reported in fathers in the general population. High satisfaction with family support was associated with a lower incidence of probable PPD among gay fathers. Increased awareness of the potential for PPD in gay fathers can improve early diagnosis and treatment.

Risk factors for postpartum depression among sexual minority and heterosexual parents

OBJECTIVE

Postpartum depression (PPD), a major depressive episode with postpartum onset, develops in 15% of mothers. Although findings suggest sexual minority parents may be at risk for PPD, research among this population is scarce. We evaluated risk factors for PPD in a sample of sexual minority and heterosexual parents.

METHOD

Four hundred and twenty seven heterosexual and one hundred and eleven sexual minority parents responded to a questionnaire distributed via social media that included demographics, the Edinburgh Postnatal Depression Scale, and the Multidimensional Scale of Perceived Social Support.

RESULTS

Sexual minority identity was not associated with increased risk for PPD. Pregnancy had no significant effect on the likelihood for PPD. Social support was negatively and significantly associated with probability for PPD.

CONCLUSIONS

Our data suggest that sexual minority parents are not at increased risk for PPD, contrary to previous findings. The parental role, a psychosocial factor, is a more dominant risk factor than pregnancy itself, in the development of PPD.

LGBTQ2S+ childbearing individuals and perinatal mental health: A systematic review

BACKGROUND

The perinatal period may uniquely impact the mental health and wellbeing of lesbian, gay, bisexual, transgender, queer, and Two-Spirit (LGBTQ2S+) childbearing individuals.

OBJECTIVES

To characterise and synthesise the experiences of LGBTQ2S+ childbearing individuals regarding perinatal mental health, including symptomatology, access to care and care-seeking.

SEARCH STRATEGY

We conducted and reported a systematic review following PRISMA guidelines of eight databases (EMBASE, MEDLINE-OVID, CINAHL, Scopus, Web of Science: Core Collection, Sociological Abstracts, Social Work Abstract, and PsycINFO) from inception to 1 March 2021.

SELECTION CRITERIA

Original, peer-reviewed research related to LGBTQ2S+ mental health was eligible for inclusion if the study was specific to the perinatal period (defined as pregnancy planning, conception, pregnancy, childbirth, and first year postpartum; includes miscarriages, fertility treatments and surrogacy).

DATA COLLECTION AND ANALYSIS

Findings were synthesised qualitatively via meta-aggregation using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI), and the ConQual approach.

MAIN RESULTS

Our systematic search included 26 eligible studies encompassing 1199 LGBTQ2S+ childbearing participants. Using the JBI SUMARI approach, we reported 65 results, which we synthesised as six key findings. The studies described unique considerations for LGBTQ2S+ individuals' perinatal mental health, including heteronormativity, cisnormativity, isolation, exclusion from traditional pregnancy care, stigma, and distressing situations from the gendered nature of pregnancy. Many participants described a lack of knowledge from healthcare providers related to care for LGBTQ2S+ individuals. In addition, LGBTQ2S+ individuals described barriers to accessing mental healthcare and gaps in health systems. Strategies to improve care include provider education, avoidance of gendered language, documentation of correct pronouns, trauma-informed practices, cultural humility training and tailored care for LGBTQ2S+ people.

CONCLUSIONS

Pregnancy, postpartum, and the perinatal period uniquely impacts the mental health and wellbeing of LGBTQ2S+individuals, largely due to systems-level inequities and exclusion from perinatal care. Healthcare providers should implement the identified strategies to improve perinatal care and address inequities.

Perinatal mental health around the world: priorities for research and service development in The Netherlands

The Netherlands has an unique system of perinatal and postpartum healthcare. Pregnancy care is delivered predominantly by primary care midwives and childbirth services predominantly involve hospital care. The first week postpartum, all women receive daily care from maternity nurses. In addition, hospitals and out-patient clinics offer perinatal mental healthcare. More specifically, ‘POP care’ (psychiatry, obstetrics and paediatrics) was developed to promote multidisciplinary collaboration in this regard. Although clinical practices and government initiatives to improve pregnancy-related mental healthcare work well, they have yet to be fully described and evaluated. The current COVID-19 pandemic has an impact on health services and perinatal mental health.

Prevalence and risk factors associated with perinatal depression in sexual minority women

Perinatal depression is associated with wide-ranging negative outcomes for women and their families, though little research has examined perinatal depression in sexual minority women. We examined depression in sexual minority women in the perinatal period, and whether there were unique minority stress-related risk and protective factors that predicted perinatal depression. One hundred ninety-four perinatal sexual minority women aged 18 years and older were recruited from the US and Australia. Participants completed an online questionnaire incorporating the Edinburgh Postnatal Depression Scale (EPDS) and measures of minority stress and social support. Over one third (35.6%) of the sample scored in the clinical range on the EPDS. Experiences of discrimination were associated with greater depression symptoms via poor social support from family. Higher concealment motivation was associated with greater depression symptoms via poor family and partner support. There were no direct or indirect effects of internalized stigma on depression. Rates of clinically elevated perinatal depression symptoms among sexual minority women are high, extending previous research demonstrating mental health disparities between sexual minorities and their heterosexual counterparts to the perinatal period. The role of social support in mediating the relationships between minority stress and depression suggests that increasing partner and family support might be effective targets for therapeutic interventions during the perinatal period.

Assessing the Mental Health of Fathers, Other Co-parents, and Partners in the Perinatal Period: Mixed Methods Evidence Synthesis

Introduction: Five to 10 percentage of fathers experience perinatal depression and 5-15% experience perinatal anxiety, with rates increasing when mothers are also experiencing perinatal mental health disorders. Perinatal mental illness in either parent contributes to adverse child and family outcomes. While there are increasing calls to assess the mental health of both parents, universal services (e.g., maternity) and specialist perinatal mental health services usually focus on the mother (i.e., the gestational parent). The aim of this review was to identify and synthesize evidence on the performance of mental health screening tools and the acceptability of mental health assessment, specifically in relation to fathers, other co-parents and partners in the perinatal period. Methods: A systematic search was conducted using electronic databases (MEDLINE, PsycINFO, Maternity, and Infant Care Database and CINAHL). Articles were eligible if they included expectant or new partners, regardless of the partner's gender or relationship status. Accuracy was determined by comparison of screening tool with diagnostic interview. Acceptability was predominantly assessed through parents' and health professionals' perspectives. Narrative synthesis was applied to all elements of the review, with thematic analysis applied to the acceptability studies. Results: Seven accuracy studies and 20 acceptability studies were included. The review identified that existing evidence focuses on resident fathers and assessing depression in universal settings. All accuracy studies assessed the Edinburgh Postnatal Depression Scale but with highly varied results. Evidence on acceptability in practice is limited to postnatal settings. Amongst both fathers and health professionals, views on assessment are mixed. Identified challenges were categorized at the individual-, practitioner- and service-level. These include: gendered perspectives on mental health; the potential to compromise support offered to mothers; practitioners' knowledge, skills, and confidence; service culture and remit; time pressures; opportunity for contact; and the need for tools, training, supervision and onward referral routes. Conclusion: There is a paucity of published evidence on assessing the mental health of fathers, co-mothers, step-parents and other partners in the perinatal period. Whilst practitioners need to be responsive to mental health needs, further research is needed with stakeholders in a range of practice settings, with attention to ethical and practical considerations, to inform the implementation of evidence-based assessment.

Reproductive and Pregnancy Experiences of Diverse Sexual Minority Women: A Descriptive Exploratory Study

Objectives This study sought to explore how sexual minority women (SMW) and heterosexual women compare in terms of reproductive history, with a particular focus on examining within-group differences among SMW. Methods Women were predominantly recruited through consecutive sampling during presentation for prenatal care in Toronto Canada, and Massachusetts, USA. In total, 96 partnered pregnant women (62 SMW, 34 heterosexual) completed an internet survey during 2013-2015. Results We found few significant differences in reproductive history outcomes when comparing SMW and heterosexual groups. However, when we compared male-partnered SMW to female-partnered SMW, we found potentially important differences in rates of miscarriage and pregnancy complications, indicating that partner gender may be an important contributor to differences in reproductive history among SMW. Conclusions for Practice These findings highlight the need to recognize the unique health risks with which male-partnered SMW may present. Considering that this group is often invisible in clinical practice, the findings from this exploratory study have important implications for providers who treat women during the transition to parenthood. Future research should further examine the differences in social and health access within larger samples of SMW groups, as well as seek to understand the complex relationships between sexual identity and perinatal health for this understudied group of women.

Health and Access to Care among Reproductive-Age Women by Sexual Orientation and Pregnancy Status

BACKGROUND

A large body of research has documented disparities in health and access to care among sexual minority populations, but very little population-based research has focused on the health care needs among pregnant sexual minority women.

METHODS

Data for this study came from 3,901 reproductive-age (18-44 years) women who identified as lesbian or bisexual and 63,827 reproductive-age women who identified as heterosexual in the 2014-2016 Behavioral Risk Factor Surveillance System. Logistic regression models were used to compare health care access, health outcomes, and health behaviors by sexual orientation and pregnancy status while controlling for demographic characteristics and socioeconomic status.

RESULTS

Approximately 3% of reproductive-age sexual minority women were pregnant. Pregnant sexual minority women were more likely to have unmet medical care needs owing to cost, frequent mental distress, depression, poor/fair health, activity limitations, chronic conditions, and risky health behaviors compared with pregnant heterosexual women. Nonpregnant sexual minority women were more likely to report barriers to care, activity limitations, chronic conditions, smoking, and binge drinking compared with nonpregnant heterosexual women. Health outcomes were similar between pregnant and nonpregnant sexual minority women, but pregnant sexual minority women were more likely to smoke cigarettes every day compared with other women.

CONCLUSIONS

This study adds new population-based research to the limited body of evidence on health and access to care for pregnant sexual minority women who may face stressors, discrimination, and stigma before and during pregnancy. More research and programs should focus on perinatal care that is inclusive of diverse families and sexual orientations.

Perceptions of partner support among pregnant plurisexual women: A qualitative study

Although partner support is an established determinant of mental health, we know little about bisexual and other plurisexual people's experiences of support from their partners. Further, very limited research has examined how bisexual or plurisexual people experience partner support during pregnancy, a significant life stage for many couples. This paper draws from semi-structured interviews with 29 plurisexual women partnered with different-gender (i.e., cisgender male or transgender) partners to examine women's perceptions of partner support during pregnancy. While participants reported many of the same partner support issues and dynamics that have been described in research with monosexual childbearing women, their experiences as plurisexual women were unique in two regards: a) unconditional acceptance from partners was connected to the partner's support for their plurisexual identities/histories; and b) social integration support often included shared integration into social networks related to their plurisexual experiences, including sexual networks. These findings offer important implications for sexual and relationship therapists, who can play an important role in helping to foster these plurisexual-specific forms of partner support, and in so doing, improve outcomes for women during this significant life stage.

Addressing Health Care Disparities Among Sexual Minorities

There is evidence of health disparities between sexual minority and heterosexual populations. Although the focus of lesbian, gay, bisexual, and transgender health research has been human immunodeficiency virus/acquired immunodeficiency syndrome and sexually transmitted infection among men who have sex with men, there are health disparities among sexual minority women. Using the minority stress framework, these disparities may in part be caused by individual prejudice, social stigma, and discrimination. To ensure equitable health for all, there is urgent need for targeted culturally sensitive health promotion, cultural sensitivity training for health care providers, and intervention-focused research.

Unintended Pregnancy, Depression, and Hazardous Drinking in a Community-Based Sample of Sexual Minority Women

CONTEXT

Unintended pregnancy is a stressful life event with important implications for women's health. Little research has examined sexual minority women's (SMW; lesbian, bisexual, mostly heterosexual) experiences of unintended pregnancy, and no studies have examined the relationship between unintended pregnancy, mental health, and negative coping behaviors in this population.

METHODS

We used the Chicago Health and Life Experiences of Women (CHLEW) Study (n = 454), a diverse sample of SMW, to examine the relationship between self-reported unintended pregnancy, depressive symptoms, and hazardous drinking. We used generalized linear model-building techniques and adjusted for key sociodemographic controls, as well as unintended pregnancy risk factors, including childhood physical and sexual abuse and age of sexual debut.

RESULTS

Twenty-four percent of the sample reported an unintended pregnancy. SMW who reported unintended pregnancies also reported significantly more depressive symptoms and greater risk of hazardous drinking. Adjusting for childhood abuse explained the relationship between unintended pregnancy and depressive symptoms, but not the relationship between unintended pregnancy and hazardous drinking.

CONCLUSIONS

Unintended pregnancy among SMW is an understudied topic. Our results suggest that unintended pregnancy is not uncommon among SMW and highlight the need for more research to investigate the mechanisms that link unintended pregnancy to depression and to hazardous drinking within this population.

Postpartum depression among visible and invisible sexual minority women: a pilot study

PURPOSE

Significant numbers of sexual minority women are choosing to parent. Despite this, there is limited research on postpartum depression (PPD) with sexual minority mothers and less research considering differences within sexual minority women in the experience of PPD. This research examines two questions to address this gap in research: (1) Do experiences of PPD symptoms vary between different subgroups of sexual minority women, and (2) Which recruitment strategies effectively address the challenge of recruiting sexual minority women who are pregnant?

METHODS

Two Canadian studies recruited participants via consecutive or convenience sampling from midwifery clinics and hospital sites. Participants completed prenatal and postnatal measures of PPD symptoms, social support, and perceived discrimination.

RESULTS

Considering our first question, we found an interaction effect between past sexual behavior and current partner gender. Women currently partnered with men reported higher scores on the Edinburgh Postpartum Depression Scale when their sexual history included partners of more than one gender, whereas this effect was not found among women who were currently partnered with women or not partnered. Regarding our second question, most sexual minority participants recruited through convenience sampling were partnered with women and identified as lesbian or queer, while most participants recruited through consecutive sampling were partnered with men and identified as bisexual.

CONCLUSIONS

Women whose sexual histories include more than one gender and are currently partnered with men may be at a higher risk for PPD symptoms. Recruitment method may influence the type of sample recruited for perinatal mental health research among sexual minority women.

Fertility-related research needs among women at the margins

Fertility-related research encompasses fertility intentions, preconception care, research amongst pregnant women, and post-partum outcomes of mothers and children. However, some women remain under-represented within this domain of study. Women frequently missing within fertility-related research include those who are already the most vulnerable to health disparities, including female sex workers, lesbian, gay, bisexual, and transgender women, women living with HIV, and women who use drugs. Yet characterization of the needs of these women is important, given their unique fertility-related concerns, including risks and barriers to care emanating from social stigmas and discrimination. This synthesis provides an overview of fertility-related evidence, highlighting where there are clear research gaps among marginalized women and the potential implications of these data shortfalls. Overall, research among marginalized women to date has addressed pregnancy prevention and in some cases fertility intentions, but the majority of studies have focused on post-conception pregnancy safety and the well-being of the child. However, among female sex workers specifically, data on pregnancy safety and the well-being of the child are largely unavailable. Within each marginalized group, preconception care and effectiveness of conception methods are consistently understudied. Ultimately, the absence of epidemiologic, clinical and programmatic evidence limits the availability and quality of reproductive health services for all women and prevents social action to address these gaps.

Modifiable partner factors associated with perinatal depression and anxiety: a systematic review and meta-analysis

BACKGROUND

Perinatal distress is a significant public health problem that adversely impacts the individual and their family. The primary objective of this systematic review and meta-analysis was to identify factors that partners can modify to protect each other from developing perinatal depression and anxiety.

METHOD

In accordance with the PRISMA statement, we reviewed the risk and protective factors associated with perinatal depression and anxiety symptoms that partners can potentially modify without professional assistance (PROSPERO reference CRD42014007524). Participants were new or expectant parents aged 16 years or older. The partner factors were sub-grouped into themes (e.g., instrumental support) based on a content analysis of the scale items and measure descriptions. A series of meta-analyses were conducted to estimate the pooled effect sizes of associations.

RESULTS

We included 120 publications, reporting 245 associations with depression and 44 with anxiety. Partner factors with sound evidence that they protect against both perinatal depression and anxiety are: emotional closeness and global support. Partner factors with a sound evidence base for depression only are communication, conflict, emotional and instrumental support, and relationship satisfaction.

LIMITATIONS

This review is limited by the lack of generalizability to single parents and the inability to systematically review moderators and mediators, or control for baseline symptoms.

CONCLUSION

The findings suggest that future prevention programs targeting perinatal depression and anxiety should aim to enhance relationship satisfaction, communication, and emotional closeness, facilitate instrumental and emotional support, and minimize conflict between partners.

Expanded care for women and families after preterm birth

Prematurity is a complication of pregnancy for 1 in 8 families in the United States. The focus of care after preterm birth shifts to the fragile newborn, while the needs of the woman and her family may be overlooked. There are many challenges for parents, including impaired parent-newborn attachment, difficulties with breastfeeding, postpartum mental health, and family disruption. Premature birth may even risk the developing relationship between parents and their child. Comprehensive care is recommended for parents who have experienced a preterm birth, including support of effective lactation, promotion of skin-to-skin care, reflection on the birth experience, support and evaluation of postpartum mental health, and provision of family-centered care. Preconception care after preterm birth needs to include guidance about the recurrence risk for preterm birth as well as recommendations for risk reduction.

Symptoms of anxiety and depression in lesbian couples treated with donated sperm: a descriptive study

Objective

To investigate symptoms of anxiety and depression in lesbian couples undergoing assisted reproductive treatment (ART), and to study the relationship of demographic data, pregnancy outcome and future reproductive plans with symptoms of anxiety and depression.

Design

Descriptive, a part of the prospective longitudinal ‘Swedish study on gamete donation’.

Setting

All university clinics in Sweden performing gamete donation.

Population

A consecutive sample of 214 lesbian couples requesting assisted reproduction, 165 of whom participated.

Methods

Participants individually completed three study-specific questionnaires and the Hospital Anxiety and Depression Scale (HADS): time point 1 (T1), at commencement of ART; time point 2 (T2), approximately 2 months after treatment; and time point 3 (T3), 2–5 years after first treatment.

Main outcome measures

Anxiety and depression (HADS), pregnancy outcome and future reproductive plans.

Results

The vast majority of lesbian women undergoing assisted reproduction reported no symptoms of anxiety and depression at the three assessment points. A higher percentage of the treated women, compared with the partners, reported symptoms of anxiety at T2 (14% versus 5%, P = 0.011) and T3 (10% versus 4%, P = 0.018), as well as symptoms of depression at T2 (4% versus 0%, P = 0.03) and T3 (3% versus 0%, P = 0.035). The overall pregnancy outcome was high; almost three-quarters of lesbian couples gave birth 2–5 years after sperm donation treatments. Open-ended comments illustrated joy and satisfaction about family building.

Conclusion

Lesbian women in Sweden reported good psychological health before and after treatment with donated sperm.

Predictors of maternal depression in the first year postpartum: marital status and mediating role of relationship quality

Existing literature has documented the associations between marital status and maternal depression within the first year postpartum. Using data that is representative of urban non-marital births in the United States with a large over-sample of non-marital births, we investigate the association of maternal depression with not only marital status but also relationship quality with the father of the baby. Quality is independently associated with maternal depression after controlling for marital status and other variables that have been documented as risk factors for maternal depression. In addition, relationship quality explains away the associations between marital status and maternal depression. After controlling for relationship quality, single women were no more likely to be depressed compared to married or cohabiting women.

Pregnancy loss in lesbian and bisexual women: an online survey of experiences

BACKGROUND

Although pregnancy loss is a distressing health event for many women, research typically equates women's experiences of pregnancy loss to ‘married heterosexual women's experiences of pregnancy loss’. The objective of this study was to explore lesbian and bisexual women's experiences of miscarriage, stillbirth and neonatal death.

METHODS

This study analysed predominantly qualitative online survey data from 60 non-heterosexual, mostly lesbian, women from the UK, USA, Canada and Australia. All but one of the pregnancies was planned. Most respondents had physically experienced one early miscarriage during their first pregnancy, although a third had experienced multiple losses.

RESULTS

The analysis highlights three themes: processes and practices for conception; amplification of loss; and health care and heterosexism. Of the respondents, 84% conceived using donor sperm; most used various resources to plan conception and engaged in preconception health care. The experience of loss was amplified due to contextual factors and the investment respondents reported making in impending motherhood. Most felt that their loss(es) had made a ‘significant’/‘very significant’ impact on their lives. Many respondents experienced health care during their loss. Although the majority rated the overall standard of care as ‘good’/‘very good’/‘outstanding’, a minority reported experiencing heterosexism from health professionals.

CONCLUSIONS

The implications for policy and practice are outlined. The main limitation was that the inflexibility of the methodology did not allow the specificities of women's experiences to be probed further. It is suggested that both coupled and single non-heterosexual women should be made more visible in reproductive health and pregnancy loss research.