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Exner F, Caspers R, Kennes LN, Wittenborn J, Kupec T, Stickeler E, Najjari L. Digital Examination vs. 4D Transperineal Ultrasound-Do They Compare in Labour Management? A Pilot Study. Diagnostics (Basel) 2024; 14:293. [PMID: 38337809 PMCID: PMC10854967 DOI: 10.3390/diagnostics14030293] [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: 12/23/2023] [Revised: 01/11/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
The aim was to compare transperineal ultrasound (TPU) with parameters of the Bishop Score during the first stage of labour and evaluate how TPU can contribute towards improving labour management. Digital examination (DE) and TPU were performed on 42 women presenting at the labour ward with regular contractions. TPU measurements included the head-symphysis distance, angle of progression, diameter of the cervical wall, cervical dilation (CD) and cervical length (CL). To examine if TPU can monitor labour progress, correlations of TPU parameters were calculated. Agreement of DE and TPU was examined for CL and CD measurements and for two groups divided into latent (CD < 5 cm) and active stages of labour (CD ≥ 5 cm). TPU parameters indicated a moderate negative correlation of CD and CL (Pearson: r = -0.667; Spearman = -0.611). The other parameters showed a weak to moderate correlation. DE and TPU measurements for CD showed better agreement during the latent stage than during the active stage. The results of the present study add to the growing evidence that TPU may contribute towards an improved labour management, suggesting a combined approach of TPU and DE to monitor the latent first stage of labour and using only DE during the active stage of labour.
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Affiliation(s)
- Friederike Exner
- Department of Gynaecology and Obstetrics, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Rebecca Caspers
- Department of Gynaecology and Obstetrics, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Lieven Nils Kennes
- Department of Economics and Business Administration, Hochschule Stralsund, 18435 Stralsund, Germany
| | - Julia Wittenborn
- Department of Gynaecology and Obstetrics, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Tomás Kupec
- Department of Gynaecology and Obstetrics, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Elmar Stickeler
- Department of Gynaecology and Obstetrics, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Laila Najjari
- Department of Gynaecology and Obstetrics, University Hospital RWTH Aachen, 52074 Aachen, Germany
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Hassdenteufel K, Müller M, Abele H, Brucker SY, Graf J, Zipfel S, Bauer A, Jakubowski P, Pauluschke-Fröhlich J, Wallwiener M, Wallwiener S. Using an Electronic Mindfulness-based Intervention (eMBI) to improve maternal mental health during pregnancy: Results from a randomized controlled trial. Psychiatry Res 2023; 330:115599. [PMID: 37988816 DOI: 10.1016/j.psychres.2023.115599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/08/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
Prevalence rates of peripartum depression and anxiety are high and correlate with adverse maternal and neonatal outcomes. Mindfulness-based interventions (MBI) have been shown to reduce mental distress during pregnancy. A multicenter, randomized controlled study was conducted after screening for depressive symptoms. The intervention group (IG) was given access to an 8-week supervised eMBI between weeks 29 and 36 of pregnancy and followed up to 5 months postpartum. Psychometric data were collected using the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory (STAI), the Pregnancy-Related Anxiety Questionnaire (PRAQ-R), the Freiburg Mindfulness Inventory (FMI-14) as well as the Patient Health Questionnaire (PHQ). Out of 5299 pregnant women, 1153 scored >9 on the EPDS and N = 460 were included in the RCT. No significant interaction effects for depressive symptoms and anxiety were found. Pregnancy- and birth-related anxiety decreased significantly in the IG and 6 weeks after birth, the rate of women at risk for adverse mental outcome was significantly lower compared to the CG. Mindfulness scores improved significantly in the IG. The eMBI program did not show effective regarding general depressive or anxiety symptoms, however, positive results were demonstrated regarding pregnancy and birth-related anxiety and the prevention of postpartum depression.
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Affiliation(s)
- Kathrin Hassdenteufel
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany.
| | - Mitho Müller
- Department of Psychology, Ludwig Maximilian University, Munich, Germany
| | - Harald Abele
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Sara Yvonne Brucker
- Department of Women's Health, University Hospital Tübingen, Tübingen, 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
| | - Armin Bauer
- Department of Women's Health, Research Institute for Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Peter Jakubowski
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | | | - Markus Wallwiener
- Department of Gynecology, Martin Luther University of Halle-Wittenberg, Halle, Germany
| | - Stephanie Wallwiener
- Department of Obstetrics and Prenatal Medicine, Martin Luther University of Halle-Wittenberg, Halle, Germany
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Fairbrother N, Keeney CL, Albert AK. Interest in prenatal stress management training: association with medical risk and mental health. J Reprod Infant Psychol 2023:1-15. [PMID: 37675936 DOI: 10.1080/02646838.2023.2254800] [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: 03/24/2022] [Accepted: 10/24/2022] [Indexed: 09/08/2023]
Abstract
OBJECTIVE The objective of this study was to document levels of interest in stress management training (SMT) during pregnancy, including differences in interest in SMT across levels of medical risk in pregnancy. We also sought to assess differences in pregnancy-specific stress, prenatal worry and depressed mood across levels of medical risk in pregnancy and investigate predictors of interest in SMT. METHODS We surveyed 379 English-speaking, pregnant people living in Vancouver, Canada, between November 2007 and November 2010. Questionnaires were administered during the third trimester and assessed interest and preferred format of SMT, pregnancy-specific stress, prenatal worry, depressed mood and medical risk in pregnancy. RESULTS Interest in stress management training programmes during pregnancy was common, with 32% of participants being quite-to-very interested. Preference was split between self-guided study (41%), group counselling (38%) and one-on-one counselling (34%). Higher pregnancy-specific stress and depressed mood, but not medical risk in pregnancy, were associated with higher interest in SMT. Participants experiencing higher stress levels or lower medical risk were more interested in one-on-one counselling. CONCLUSION Findings indicate that subjective distress rather than objective circumstances is a better predictor of interest in SMT. Care providers should inquire early-on about interest in SMT during pregnancy and ensure awareness of SMT options.
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Affiliation(s)
- Nichole Fairbrother
- Department of Family Practice, The University of British Columbia, Vancouver, Canada
| | - Cora L Keeney
- Department of Family Practice, The University of British Columbia, Vancouver, Canada
| | - Arianne K Albert
- Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada
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4
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Shirabe R, Okada H, Okuhara T, Yokota R, Kiuchi T. Development of the Japanese Version of Pregnancy-Related Anxiety Questionnaire-Revised-2: Measurement and Psychometric Properties. Healthcare (Basel) 2023; 11:1935. [PMID: 37444768 DOI: 10.3390/healthcare11131935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/23/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
Tools to evaluate pregnancy-specific anxiety are lacking in Japan. This study aimed to develop a Japanese version of the Pregnancy-Related Anxiety Questionnaire-Revised-2. After scale translation and cognitive interviews, we conducted a cross-sectional study among 120 ≥18-year-old, singleton (pregnant with one baby) Japanese women before 15 weeks of pregnancy, recruited from four facilities. A total of 112 women completed the questionnaires. We tested the internal consistency, measurement error and reliability, structural validity, measurement invariance across nulliparous and parous women, construct validity by calculating omega, standard error of measurement (SEM), intraclass correlation coefficient (ICC), confirmatory factor analysis (CFA), multigroup CFA, multitrait-scaling analysis, correlational analyses with other measurements, and t-test to compare nulliparous and parous groups. Omega was 0.90 for the total score. SEM was 3.4 and ICC was 0.76. The CFA revealed an optimal fit for the three-factor model based on the original scale. Multigroup CFA supported measurement invariance across the nulliparous and parous groups, and multitrait-scaling analysis revealed 100% scaling success. The correlation coefficients with other scales of childbirth anxiety and general anxiety were 0.70 and 0.24. The mean total score of the nulliparous women was higher than that of the parous women (34.5 vs. 30.3, p = 0.001). Therefore, the scale was determined to have good validity and reliability.
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Affiliation(s)
- Ritsuko Shirabe
- Department of Health Communication, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hiroko Okada
- Department of Health Communication, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Tsuyoshi Okuhara
- Department of Health Communication, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Rie Yokota
- Department of Health Communication, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Takahiro Kiuchi
- Department of Health Communication, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
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Sutcliffe KL, Levett K, Dahlen HG, Newnham E, MacKay LM. How Do Anxiety and Relationship Factors Influence the Application of Childbirth Education Strategies During Labor and Birth: A Bowen Family Systems Perspective. Int J Womens Health 2023; 15:455-465. [PMID: 37033120 PMCID: PMC10075222 DOI: 10.2147/ijwh.s399588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/24/2023] [Indexed: 04/03/2023] Open
Abstract
The effectiveness of childbirth education (CBE) has long been debated with studies showing contradictory outcomes for mothers and babies. Understanding how what is learned in CBE is translated into practice during labor and birth is an area that requires investigation as this may be a mediating factor in its effectiveness. Bowen family system theory's concept of differentiation of self, the ability to be guided by and to act from one's beliefs and values, is an organizing principle that may affect how relational factors affect the use and application of CBE at the time of birth. The ability to act with emotional maturity when faced with a stressor, such as childbirth, depends on an individual's capability to separate thoughts from the more reactive feeling process. Recognizing how one's level of differentiation interacts with the anxious responses of others may assist pregnant women and birth partners to make decisions more objectively about how they want to manage the birthing process. For the health professional, understanding the interplay of relationship variables, physiological stress, anxiety and individual reactivity may allow for the provision of more thoughtful evidence-based practice, which may increase objectivity, and aid communication and decision-making for women during birth. Bowen theory, as a comprehensive systems-based approach to understanding human functioning under stress, offers a novel approach to exploring the application of CBE during birth.
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Affiliation(s)
- Kerry L Sutcliffe
- School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia
- Correspondence: Kerry L Sutcliffe, School of Medicine, University of Notre Dame Australia, Auburn Clinical School, 88-90 Water Street, Auburn, Sydney, NSW, 2144, Australia, Tel +61 451771723, Email
| | - Kate Levett
- School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia
- Adjunct Fellow, NICM Health Research Institute, and THRI, Western Sydney University, Sydney, NSW, Australia
- Honorary Fellow, Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Hannah G Dahlen
- School of Nursing & Midwifery, Western Sydney University, Sydney, NSW, Australia
| | - Elizabeth Newnham
- School of Nursing & Midwifery, University of Newcastle, Newcastle, NSW, Australia
| | - Linda M MacKay
- School of Arts & Sciences, University of Notre Dame Australia, Sydney, NSW, Australia
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Peltonen H, Paavonen EJ, Saarenpää-Heikkilä O, Vahlberg T, Paunio T, Polo-Kantola P. Sleep disturbances and depressive and anxiety symptoms during pregnancy: associations with delivery and newborn health. Arch Gynecol Obstet 2023; 307:715-728. [PMID: 35461389 PMCID: PMC9984335 DOI: 10.1007/s00404-022-06560-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 04/01/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Sleep disturbances and mood symptoms are common in late pregnancy; according to the literature, they can affect delivery and newborn outcomes. This study evaluated the effect of sleep and mood symptoms on delivery and newborn health, because there are insufficient and partly contradictory studies on the topic. METHODS A cohort of 1414 mothers in their third trimester was enrolled in this prospective cross-sectional questionnaire study. Validated questionnaires were assessed for the measurement of sleep disturbances and depressive and anxiety symptoms. The data on delivery and newborn outcomes were obtained from hospital medical records. RESULTS Sleep disturbances were very common. A higher insomnia score (β = - 0.06, p = 0.047) and longer sleep need (β = 0.07, p = 0.047) were related to delivery at a lower gestational age. In addition, a higher insomnia score (β = - 28.30, p = 0.010) and lower general sleep quality (β = - 62.15, p = 0.025) were associated with lower birth weight, but longer sleep duration and longer sleep need with a higher birth weight (β = 28.06, p = 0.019; β = 27.61, p = 0.028, respectively). However, the findings regarding birth weight lost their significance when the birth weight was standardized by gestational weeks. Concerning Apgar scores and umbilical artery pH, no associations were found. Snoring was associated with a shorter duration of the first phase of delivery (β = - 78.71, p = 0.015) and total duration of delivery (β = - 79.85, p = 0.016). Mothers with higher insomnia, depressive, or anxiety symptoms were more often treated with oxytocin (OR 1.54 95% CI 1.00-2.38, p = 0.049, OR 1.76, 95% CI 1.02-3.04, p = 0.049 and OR 1.91, CI 95% 1.28-2.84, p < 0.001, respectively) and those with higher depressive and anxiety symptoms were delivered more often with elective cesarean section (OR 4.67, 95% CI 2.04-12.68, p < 0.001 and OR 2.22, 95% CI 1.03-4.79, p = 0.042). CONCLUSIONS Maternal sleep disturbances and mood symptoms during pregnancy are associated with delivery and newborn health. However, nearly, all the outcomes fell within a normal range, implying that the actual risks are low.
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Affiliation(s)
- Hilla Peltonen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland.
| | - E Juulia Paavonen
- Pediatric Research Center, Child Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Outi Saarenpää-Heikkilä
- Centre for Child Health Research, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Tero Vahlberg
- Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland
| | - Tiina Paunio
- Department of Psychiatry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland.,Sleep Research Unit, University of Turku, Turku, Finland
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7
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Dumont É, Ogez D, Nahas S, El-Baalbaki G. The Use of Hypnosis during the Perinatal Period: A Systematic Review. Int J Clin Exp Hypn 2023; 71:25-47. [PMID: 36622308 DOI: 10.1080/00207144.2022.2160258] [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: 01/10/2023]
Abstract
This systematic review aims to identify current protocols involving the use of hypnosis during the perinatal period and to examine its effects on mothers' well-being. Seven electronic databases were searched for articles published from 1960 to April 1, 2021, that assessed the effectiveness of hypnosis during the perinatal period. All published randomized, controlled trials and nonrandomized, controlled trials studies assessing the effectiveness of hypnosis used during the perinatal period with healthy adult women were included. The quality of the included studies was assessed using the Risk of Bias in Nonrandomized Studies of Interventions or the Revised Cochrane risk-of-bias tool for randomized trials. Article screening, methodological-quality assessment, and data extraction were performed by 2 independent reviewers. Twenty-one articles, corresponding to 16 studies met inclusion criteria. Apart from 2 studies, all included studies reported the benefits of implementing a hypnosis intervention during the perinatal period. However, methodological limitations relative to intervention implementation and assessment methods might have led to the observed variability in results across studies. Future studies should consider a more standardized methodology.
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Affiliation(s)
- Émilie Dumont
- Department of Psychology, Université du Québec à Montréal, Canada
| | - David Ogez
- Department of Psychology, Université du Québec à Montréal, Canada.,Department of Anesthesiology and Pain Medicine, Université de Montréal, Québec, Canada.,Clinique de la gestion de la douleur, Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est-de-l'île de Montréal, Québec, Canada
| | - Sabine Nahas
- Department of Psychology, Université du Québec à Montréal, Canada
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Loughnan SA, Gautam R, Silverio SA, Boyle FM, Cassidy J, Ellwood D, Homer C, Horey D, Leisher SH, de Montigny F, Murphy M, O'Donoghue K, Quigley P, Ravaldi C, Sandall J, Storey C, Vannacci A, Wilson AN, Flenady V. Multicountry study protocol of COCOON: COntinuing Care in COVID-19 Outbreak global survey of New, expectant, and bereaved parent experiences. BMJ Open 2022; 12:e061550. [PMID: 36691138 PMCID: PMC9445233 DOI: 10.1136/bmjopen-2022-061550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/25/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Globally, the COVID-19 pandemic has significantly disrupted the provision of healthcare and efficiency of healthcare systems and is likely to have profound implications for pregnant and postpartum women and their families including those who experience the tragedy of stillbirth or neonatal death. This study aims to understand the psychosocial impact of COVID-19 and the experiences of parents who have accessed maternity, neonatal and bereavement care services during this time. METHODS AND ANALYSIS An international, cross-sectional, online and/or telephone-based/face-to-face survey is being administered across 15 countries and available in 11 languages. New, expectant and bereaved parents during the COVID-19 pandemic will be recruited. Validated psychometric scales will be used to measure psychosocial well-being. Data will be analysed descriptively and by assessing multivariable associations of the outcomes with explanatory factors. In seven of these countries, bereaved parents will be recruited to a nested, qualitative interview study. The data will be analysed using a grounded theory analysis (for each country) and thematic framework analysis (for intercountry comparison) to gain further insights into their experiences. ETHICS AND DISSEMINATION Ethics approval for the multicountry online survey, COCOON, has been granted by the Mater Misericordiae Human Research Ethics Committee in Australia (reference number: AM/MML/63526). Ethics approval for the nested qualitative interview study, PUDDLES, has been granted by the King's College London Biomedical & Health Sciences, Dentistry, Medicine and Natural & Mathematical Sciences Research Ethics Subcommittee (reference number: HR-19/20-19455) in the UK. Local ethics committee approvals were granted in participating countries where required. Results of the study will be published in international peer-reviewed journals and through parent support organisations. Findings will contribute to our understanding of delivering maternity care services, particularly bereavement care, in high-income, lower middle-income and low-income countries during this or future health crises.
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Affiliation(s)
- Siobhan A Loughnan
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-The University of Queensland, Brisbane, QLD, Australia
| | - Rupesh Gautam
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-The University of Queensland, Brisbane, QLD, Australia
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Frances M Boyle
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-The University of Queensland, Brisbane, QLD, Australia
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | | | - David Ellwood
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-The University of Queensland, Brisbane, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Caroline Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Dell Horey
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-The University of Queensland, Brisbane, QLD, Australia
- Department of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | | | - Francine de Montigny
- Département des Sciences Infirmières, Université du Québec en Outaouais, Gatineau, Quebec, Canada
| | - Margaret Murphy
- Nursing and Midwifery, University College Cork-National University of Ireland, Cork, Ireland
| | - Keelin O'Donoghue
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Cork, Ireland
| | - Paula Quigley
- International Stillbirth Alliance, Millburn, New Jersey, USA
- DAI Global Health, London, UK
| | - Claudia Ravaldi
- CiaoLapo Foundation for Perinatal Health, Prato, Italy
- PeaRL - Perinatal Research Laboratory, Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Firenze, Italy
| | - Jane Sandall
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Claire Storey
- International Stillbirth Alliance, Millburn, New Jersey, USA
| | - Alfredo Vannacci
- CiaoLapo Foundation for Perinatal Health, Prato, Italy
- PeaRL - Perinatal Research Laboratory, Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Firenze, Italy
| | - Alyce N Wilson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Vicki Flenady
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-The University of Queensland, Brisbane, QLD, Australia
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Mudra S, Göbel A, Möhler E, Stuhrmann LY, Schulte-Markwort M, Arck P, Hecher K, Diemert A. Behavioral Inhibition in the Second Year of Life Is Predicted by Prenatal Maternal Anxiety, Overprotective Parenting and Infant Temperament in Early Infancy. Front Psychiatry 2022; 13:844291. [PMID: 35722567 PMCID: PMC9203734 DOI: 10.3389/fpsyt.2022.844291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/16/2022] [Indexed: 11/22/2022] Open
Abstract
Background Behavioral inhibition, characterized by shyness, fear and avoidance of novel stimuli, has been linked with internalizing personality traits in childhood, adolescence and early adulthood, and particularly later social anxiety disorder. Little is known about the relevance of potential prenatal precursors and early predictors for the development of inhibited behavior, such as infant vulnerability and family risk factors like parental anxiety and overprotection. Pregnancy-related anxiety has been associated with both infant temperament and maternal overprotective parenting. Thus, the aim of this study was investigating the predictive relevance of prenatal pregnancy-related anxiety for behavioral inhibition in toddlerhood, by considering the mediating role of maternal overprotection and infant distress to novelty. Materials and Methods As part of a longitudinal pregnancy cohort, behavioral inhibition at 24 months postpartum was assessed in N = 170 mother-child pairs. Maternal pregnancy-related anxiety was examined in the third trimester of pregnancy, and maternal overprotection and infant distress to novelty at 12 months postpartum. Results Mediation analysis with two parallel mediators showed that the significant direct effect of pregnancy-related anxiety on child behavioral inhibition was fully mediated by infant distress to novelty p < 0.001 and maternal overprotection (p < 0.05). The included variables explained 26% of variance in behavioral inhibition. A subsequent explorative mediation analysis with serial mediators further showed a significant positive association between distress to novelty and maternal overprotective parenting (p < 0.05). Conclusion Results indicate a predictive relevance of both infant and maternal factors for the development of behavioral inhibition in toddlerhood. Mothers who perceived more pregnancy-related anxiety showed more overprotective parenting and had infants with more distress to novelty. Further, mothers being more overprotective reported their child to be more inhibited in toddlerhood. Our findings also indicate the stability of reported infant distress to novelty as one aspect of later behavioral inhibition. Addressing specific forms of parental anxiety from pregnancy on and in interaction with child-related variables seems to be a promising approach for future studies and clinical interventions.
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Affiliation(s)
- Susanne Mudra
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ariane Göbel
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eva Möhler
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Saarland University Medical Center, Hamburg, Germany
| | - Lydia Yao Stuhrmann
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Schulte-Markwort
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petra Arck
- Division of Experimental Feto-Maternal Medicine, Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anke Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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10
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Kazemi A, Dadkhah A. Changes in prenatal depression and anxiety levels in low risk pregnancy among Iranian women: A prospective study. Asia Pac Psychiatry 2022; 14:e12419. [PMID: 32875714 DOI: 10.1111/appy.12419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Increasing of depression and anxiety in high risk pregnancy is well known but there is limited information on the changes of psychological symptoms in low risk pregnancies and the aim of the study was evaluation depression and anxiety changes in pregnant women with high risk pregnancy. METHODS This prospective study was performed on 256 pregnant women at the beginning of the first trimester of pregnancy. Inclusion criteria included the absence of pre-pregnancy depression and anxiety and poor pregnancy history. Exclusion criteria were the incidence of pregnancy complications. The level of their depression and anxiety at the time of entering the study were completed by self-report using the DASS questionnaire at 9-10, 11-12, 24-25, and 33-35 weeks of pregnancy. RESULTS The results of the study indicated that the effect of time on the level of perinatal depression and anxiety was significant (P < .001). These findings showed that the level of depression increased significantly from 9 to 24 weeks of pregnancy and decreased in the 32-34 weeks, but did not reach the level of depression at 9 weeks of pregnancy. Also, the anxiety level increased significantly from the onset of pregnancy to the 24 weeks gestation but did not change during the second and third trimesters. CONCLUSION The results of the study showed that the level of depression and anxiety of women in low risk pregnancies increase during pregnancy and psychological health screenings in the second trimester of pregnancy should be performed in pregnant women.
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Affiliation(s)
- Ashraf Kazemi
- Reproductive Health Department, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Aazam Dadkhah
- Reproductive Health Department, Isfahan University of Medical Sciences, Isfahan, Iran
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11
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O'Mahen HA, Ramchandani PG, King DX, Lee-Carbon L, Wilkinson EL, Thompson-Booth C, Ericksen J, Milgrom J, Dunkley-Bent J, Halligan SL, Fearon P. Adapting and testing a brief intervention to reduce maternal anxiety during pregnancy (ACORN): report of a feasibility randomized controlled trial. BMC Psychiatry 2022; 22:129. [PMID: 35177019 PMCID: PMC8851863 DOI: 10.1186/s12888-022-03737-1] [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] [Received: 08/09/2021] [Accepted: 01/10/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We investigated the acceptability and feasibility of a new brief intervention for maternal prenatal anxiety within maternity services in London and Exeter, UK. METHODS One hundred fourteen pregnant individuals attending their 12-week scan at a prenatal clinic with elevated symptoms of anxiety (GAD-7 score of ≥7) were randomly assigned to either the ACORN intervention + Treatment as usual (TAU) (n = 57) or to usual care only (n = 57). The ACORN intervention consisted of 3 2-h group sessions, led by a midwife and psychological therapist, for pregnant individuals and their partners. The intervention included psychoeducation about anxiety, strategies for problem-sovling and tolerating uncertainty during pregnancy, including communicating about these with others, and mindfulness exercises. RESULTS Engagement rates with ACORN met or exceeded those in primary care services in England. In the intervention arm, 77% (n = 44) of participants attended at least one session, 51% (n = 29) were adherent, defined as attending two or more sessions. Feedback was positive, and participants in the ACORN treatment group demonstrated evidence of a larger drop in their levels of anxiety than the participants in the TAU-only group (Cohen's d = 0.42). CONCLUSION The ACORN intervention was acceptable to pregnant individuals and their partners and resulted in reductions in anxiety. With further evaluation in a larger-scale trial with child outcomes, there is significant potential for large scale public health benefit.
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Affiliation(s)
- Heather A O'Mahen
- Mood Disorders Research Centre, University of Exeter, Perry Road, Exeter, EX4 4QG, UK.
| | - Paul G Ramchandani
- Centre for Mental Health, Imperial College London, 7th Floor Commonwealth Building, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
- Central and North West London NHS Foundation Trust, Stephenson House, 75 Hampstead Road, London, NW1 2PL, UK
- Centre for Research on Play in Education, Development, and Learning, Faculty of Education, University of Cambridge, 184 Hills Road, Cambridge, CB2 8PQ, England
| | - Dorothy X King
- Centre for Mental Health, Imperial College London, 7th Floor Commonwealth Building, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
- Central and North West London NHS Foundation Trust, Stephenson House, 75 Hampstead Road, London, NW1 2PL, UK
| | - Leonie Lee-Carbon
- Centre for Mental Health, Imperial College London, 7th Floor Commonwealth Building, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - Esther L Wilkinson
- Centre for Mental Health, Imperial College London, 7th Floor Commonwealth Building, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
- Central and North West London NHS Foundation Trust, Stephenson House, 75 Hampstead Road, London, NW1 2PL, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Chloe Thompson-Booth
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- Essex Partnership University NHS Foundation Trust, Trust Head Office, The Lodge, Lodge Approach, Runwell, Wickford, Essex, SS11 7XX, UK
| | - Jennifer Ericksen
- Parent-Infant Research Institute, Centaur Building, Heidelberg Repatriation Hospital, Austin Health, 300 Waterdale Road, Heidelberg Heights, Melbourne, VIC, Australia
| | - Jeannette Milgrom
- Parent-Infant Research Institute, Centaur Building, Heidelberg Repatriation Hospital, Austin Health, 300 Waterdale Road, Heidelberg Heights, Melbourne, VIC, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Level 12, Redmond Barry Building, Parkville, VIC, 3010, Australia
| | | | - Sarah L Halligan
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Pasco Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
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12
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Sanni KR, Eeva E, Noora SM, Laura KS, Linnea K, Hasse K. The influence of maternal psychological distress on the mode of birth and duration of labor: findings from the FinnBrain Birth Cohort Study. Arch Womens Ment Health 2022; 25:463-472. [PMID: 35150311 PMCID: PMC8921080 DOI: 10.1007/s00737-022-01212-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 02/07/2022] [Indexed: 11/24/2022]
Abstract
Antepartum depression, general anxiety symptoms, and pregnancy-related anxiety have been recognized to affect pregnancy outcomes. Systematic reviews on these associations lack consistent findings, which is why further research is required. We examined the associations between psychological distress, mode of birth, epidural analgesia, and duration of labor. Data from 3619 women with singleton pregnancies, from the population-based FinnBrain Birth Cohort Study were analyzed. Maternal psychological distress was measured during pregnancy at 24 and 34 weeks, using the Pregnancy-Related Anxiety Questionnaire-Revised 2 (PRAQ-R2) and its subscale "Fear of Giving Birth" (FOC), the anxiety subscale of the Symptom Checklist-90 (SCL-90) and the Edinburgh Postnatal Depression Scale (EPDS). Mode of birth, epidural analgesia, and labor duration were obtained from the Finnish Medical Birth Register. Maternal psychological distress, when captured with PRAQ-R2, FOC, and SCL-90, increased the likelihood of women having an elective cesarean section (OR: 1.04, 95% CI 1.01-1.06, p = .003; OR: 1.13, 95% CI 1.07-1.20, p < .001; OR: 1.06, 95% CI 1.03-1.10, p = .001), but no association was detected for instrumental delivery or emergency cesarean section. A rise in both the PRAQ-R2, and FOC measurements increased the likelihood of an epidural analgesia (OR: 1.02, 95% CI 1.01-1.03, p = .003; OR: 1.09, 95% CI 1.05-1.12, p < .001) and predicted longer second stage of labor (OR: 1.01, 95% CI 1.00-1.01, p = .023; OR: 1.03, 95% CI 1.02-1.05, p < .001). EPDS did not predict any of the analyzed outcomes. The results indicate that maternal anxiety symptoms (measured using PRAQ-R2, FOC, and SCL-90) are associated with elective cesarean section. Psychological distress increases the use of epidural analgesia, but is not associated with complicated vaginal birth.
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Affiliation(s)
- Kuuri-Riutta Sanni
- Department of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, University of Turku, Lemminkäisenkatu 3a, Building: Teutori, 20014, Turku, Finland.
| | - Ekholm Eeva
- Department of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, University of Turku, Lemminkäisenkatu 3a, Building: Teutori, 20014 Turku, Finland ,Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, Turku, Finland
| | - Scheinin M. Noora
- Department of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, University of Turku, Lemminkäisenkatu 3a, Building: Teutori, 20014 Turku, Finland ,Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
| | - Korhonen S. Laura
- Department of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, University of Turku, Lemminkäisenkatu 3a, Building: Teutori, 20014 Turku, Finland ,Department of Paediatrics and Adolescent Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Karlsson Linnea
- Department of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, University of Turku, Lemminkäisenkatu 3a, Building: Teutori, 20014 Turku, Finland ,Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland ,Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
| | - Karlsson Hasse
- Department of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, University of Turku, Lemminkäisenkatu 3a, Building: Teutori, 20014 Turku, Finland ,Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland ,Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
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13
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Impact of urinary incontinence on anxiety status during pregnancy: a prospective case–control study. Eur J Obstet Gynecol Reprod Biol 2022; 270:227-230. [DOI: 10.1016/j.ejogrb.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/14/2021] [Accepted: 01/18/2022] [Indexed: 11/20/2022]
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14
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Tani F, Ghinassi S, Ponti L. The Role of Maternal Perceived Social Support on the Relation Between Prenatal Depressive Symptoms and Labor Experience. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2021. [DOI: 10.1027/2512-8442/a000103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background: Depression during pregnancy is a severe risk factor for negative outcomes in women and children. In particular, prenatal symptoms of depression are linked to a more complicated labor experience, characterized by more painful labor and more frequent recourse to epidural analgesia and/or oxytocin. Although this link is evident, less is known about possible mediators of this relationship. Aims: This study investigated the mediating role of perceived maternal social support on the relationship between prenatal maternal depression and labor experience. Methods: Participants were 152 Italian nulliparous women ( Mage = 31.68 years, SD = 4.94). Data were collected at two different times: T1 (at week 30–33 of gestation) women completed the Beck Depression Inventory and the Maternal Social Support Scale; T2 (at childbirth) clinical data regarding labor was registered from hospital records (duration of labor in hours and administration of oxytocin and epidural analgesia in hours). Results: The Structural Equation Modeling showed that prenatal symptoms of depression are linked to a more complicated labor experience (β = .31, p < .001). However, the quality of the maternal social support can mediate this relationship (indirect effect: β = .17, p < .000). Limitations: The complexity of the proposed model, the characteristics of the sample, the variables investigated, and the questionnaires used are discussed. Conclusion: The perception of having a good social network is an important predictor of women’s health in the transition to motherhood, decreasing the negative effect of maternal prenatal depressive symptoms on the quality of women’s labor experience.
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Affiliation(s)
- Franca Tani
- Department of Health Sciences, University of Florence, Italy
| | - Simon Ghinassi
- Department of Health Sciences, University of Florence, Italy
| | - Lucia Ponti
- Department of Humanities, University “Carlo Bo” of Urbino, Italy
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15
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Korn L, Koren G, Yaakov A, Madar G, Blau A. Evaluating the Effectiveness of Childbirth Preparation Courses on Women's Self-Efficacy among Ultra-Orthodox Jewish Religious Women in Israel. Healthcare (Basel) 2021; 9:818. [PMID: 34203349 PMCID: PMC8304180 DOI: 10.3390/healthcare9070818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/13/2021] [Accepted: 06/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background: This study examined the effectiveness of a birth preparation course on coping with childbirth among primigravid ultra-orthodox Jewish women in Israel. Methods: In total, 130 ultra-orthodox 25-35-week primigravid women were divided into a study (n = 100, participated in birth preparation courses) and a control (n = 30, did not participate in the courses) group. A questionnaire was delivered three times: T1-before the course/delivery, T2-two-three days after delivery, and T3-a month after delivery. Results: At T3, self-efficacy among the study group was higher than in the control group. Differences in self-efficacy were found over time regardless of the group (F(2,246) = 12.83, p < 0.001), as a time-group interaction effect (F(2,246) = 10.20, p < 0.01). Self-efficacy in the study group (Mean, M = 3.40, Standard deviation, SD = 0.63 at T1) dropped to M = 3.06, SD = 0.76 at T2 and rose to M = 3.34, SD = 0.64 at T3. In the control group, self-efficacy (M = 3.53, SD = 0.56 at T1) dropped to M = 3.26, SD = 0.63 at T2 and to M = 2.95, SD = 0.76 at T3. Discussion: The childbirth preparation course was found to be effective in raising self-efficacy among primigravid ultra-orthodox religious women when compared to the control group.
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Affiliation(s)
- Liat Korn
- Department of Health Systems Management, School of Health Sciences, Ariel University, 40700 Ariel, Israel;
| | - Gideon Koren
- Adelson School of Medicine, Ariel University, 40700 Ariel, Israel;
| | - Ayelet Yaakov
- Department of Health Systems Management, School of Health Sciences, Ariel University, 40700 Ariel, Israel;
| | - Galit Madar
- School of Communication, Ariel University, 40700 Ariel, Israel;
| | - Ayala Blau
- Department of Nursing, School of Health Sciences, Ariel University, 40700 Ariel, Israel;
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16
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Abstract
Background Between 5% and 14% of women suffer from fear of childbirth (FOC) which is associated with difficulties during birth and in postnatal psychological adjustment. Therefore, effective interventions are needed to improve outcomes for women. A systematic review and meta-analysis was used to identify effective interventions for treating women with FOC. Methods Literature searches were undertaken on online databases. Hand searches of reference lists were also carried out. Studies were included in the review if they recruited women with FOC and aimed to reduce FOC and/or improve birth outcomes. Data were synthesised qualitatively and quantitatively using meta-analysis. The literature searches provided a total of 4474 citations. Results After removing duplicates and screening through abstracts, titles and full texts, 66 papers from 48 studies were identified for inclusion in the review. Methodological quality was mixed with 30 out of 48 studies having a medium risk of bias. Interventions were categorised into six broad groups: cognitive behavioural therapy, other talking therapies, antenatal education, enhanced midwifery care, alternative interventions and interventions during labour. Results from the meta-analysis showed that most interventions reduced FOC, regardless of the approach (mean effect size = −1.27; z = −4.53, p < 0.0001) and that other talking therapies may reduce caesarean section rates (OR 0.48, 95% CI 0.48–0.90). Conclusions Poor methodological quality of studies limits conclusions that can be drawn; however, evidence suggests that most interventions investigated reduce FOC. Future high-quality randomised controlled trials are needed so that clear conclusions can be made.
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17
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Jones SMW, Banegas MP, Steiner JF, De Marchis EH, Gottlieb LM, Sharp AL. Association of Financial Worry and Material Financial Risk with Short-Term Ambulatory Healthcare Utilization in a Sample of Subsidized Exchange Patients. J Gen Intern Med 2021; 36:1561-1567. [PMID: 33469762 PMCID: PMC8175504 DOI: 10.1007/s11606-020-06479-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 12/15/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Financial burden can affect healthcare utilization. Few studies have assessed the short-term associations between material (debt, trouble paying rent) and psychological (worry or distress about affording future healthcare) financial risks, and subsequent outpatient and emergency healthcare use. Worry was defined as concerns about affording future healthcare. OBJECTIVE Examine whether worry about affording healthcare is associated with healthcare utilization when controlling for material risk and general anxiety DESIGN: Longitudinal observational study PARTICIPANTS: Kaiser Permanente members with exchange-based federally subsidized health insurance (n = 450, 45% response rate) MAIN MEASURES: Survey measures of financial risks (material difficulty paying for medical care and worry about affording healthcare) and general anxiety. Healthcare use (primary care, urgent care, emergency department, and outpatient specialty visits) in the 6 months following survey completion. KEY RESULTS Emergency department and primary care visits were not associated with material risk, worry about affording care, or general anxiety in individual and pooled analyses (all 95% confidence intervals (CI) for relative risk (RR) included 1). Although no individual predictor was associated with urgent care use (all 95% CIs for RR included 1), worry about affording prescriptions (relative risk (RR) = 2.01; 95% CI 1.14, 3.55) and general anxiety (RR = 0.38; 95% CI 0.15, 0.95) were significant when included in the same model, suggesting the two confounded each other. Worry about affording healthcare services was associated with fewer specialty care visits (RR = 0.40; 95% CI 0.25, 0.64) even when controlling for material risk and general anxiety, although general anxiety was also associated with more specialty care visits (RR = 1.98; 95% CI, 1.23, 3.18). CONCLUSIONS Screening for both general anxiety and financial worry may assist with specialty care utilization. Identifying these concerns may provide more opportunities to assist patients. Future research should examine interventions to reduce worry about cost of care.
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Affiliation(s)
| | - Matthew P Banegas
- Kaiser Permanente Oregon Center for Health Research, Portland, OR, USA
| | - John F Steiner
- Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, USA
| | - Emilia H De Marchis
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Laura M Gottlieb
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Adam L Sharp
- Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena, CA, USA
- Health Systems Science Department, Kaiser Permanente School of Medicine, Pasadena, CA, USA
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18
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Shorey SY, Ng ED, Chee CYI. Anxiety and depressive symptoms of women in the perinatal period during the COVID-19 pandemic: A systematic review and meta-analysis. Scand J Public Health 2021; 49:730-740. [PMID: 33966511 DOI: 10.1177/14034948211011793] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS The prevalence of perinatal anxiety and depressive symptoms have been speculated to increase during an infectious disease outbreak but remains unknown in the context of the COVID-19 situation. Therefore, this review aimed to examine the prevalence of antenatal and postnatal anxiety and depressive symptoms among pregnant women and postpartum mothers during the COVID-19 period. METHODS Six electronic databases were systematically searched for articles from November 2019 to December 2020. Twenty-six observational studies and brief reports were included in the meta-analysis. RESULTS Overall, the prevalence of anxiety was greater than depression in both antenatal and postnatal periods, and the prevalence of depression was higher in the antenatal period than the postnatal period. The pooled prevalence for antenatal anxiety symptoms, antenatal depressive symptoms and postnatal depressive symptoms were 40% (95% confidence intervals (CI): 0.27-0.52), 27% (95% CI: 0.20-0.33) and 17% (95% CI: 0.10-0.24), respectively. Europe (56%, 95% CI: 0.28-0.85) had significantly higher prevalence of antenatal anxiety than Asia (16%, 95% CI: 0.09-0.23). CONCLUSIONS The heightened prevalence of perinatal psychological disorders served as an impetus for healthcare professionals and policy makers to ramp up their support and mitigation strategies for pregnant women and mothers in times of health crisis.
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Affiliation(s)
- Shefal Y Shorey
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Esperanza D Ng
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cornelia Y I Chee
- Department of Psychological Medicine, National University Hospital, Singapore
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19
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Slade P, Sheen K, Weeks A, Wray S, De Pascalis L, Lunt K, Bedwell C, Thompson B, Hill J, Sharp H. Do stress and anxiety in early pregnancy affect the progress of labor: Evidence from the Wirral Child Health and Development Study. Acta Obstet Gynecol Scand 2021; 100:1288-1296. [PMID: 33543770 PMCID: PMC8359214 DOI: 10.1111/aogs.14063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/24/2020] [Accepted: 11/19/2020] [Indexed: 12/01/2022]
Abstract
Introduction Despite widespread belief that anxiety causes longer labor, evidence of association is inconsistent. Data gathered as part of a prospective epidemiological longitudinal study were used to investigate associations between antenatal anxiety and pregnancy‐specific stress, and labor progression was assessed by duration and use of augmentation. Material and methods Pregnant primiparous women completed measures for anxiety and pregnancy‐specific stress at 20 weeks’ gestation (n = 1145). Birth outcome data were extracted from medical records. Regression analyses and a path analysis assessed associations between antenatal anxiety and pregnancy‐specific stress, and indices of labor progression (labor duration and augmentation). Results Anxiety/pregnancy‐specific stress were not directly associated with duration of stage 1 labor (HIGH/LOW anxiety: mean difference = 13.94 minutes, SD = 20.66, 95% CI −26.60 to 54.49, P < .50)/(HIGH/LOW pregnancy‐specific stress: mean difference = 12.05 minutes, SD = 16.09, 95% CI −19.52 to 43.63, P < .45). However, anxiety/pregnancy‐specific stress were associated with epidural use (HIGH/LOW anxiety: 39% vs 31%, P < .042; HIGH/LOW pregnancy‐specific stress: 38% vs 29%, P < .001), which was itself associated with longer labor (mean difference: 158.79 minutes, SD = 16.76, 95% CI 125.89‐191.68, P < .001). Anxiety and pregnancy‐specific stress were associated with increased likelihood of augmentation but these associations were nonsignificant after accounting for epidural, which was itself highly associated with augmentation. However, path analysis indicated an indirect effect linking pregnancy‐specific stress, but not general anxiety, to labor duration and augmentation: elevated pregnancy‐specific stress led to greater use of epidural, which was linked to both increased rates of augmentation, and increased labor duration. Conclusions Contrary to general belief, general anxiety and specific pregnancy stress were not directly linked to longer duration of stage one labor. However specific pregnancy stress was associated with epidural use, which in turn was significantly associated with risk of augmentation, and longer stage one labor. Identification of pregnancy‐specific stress could help to identify women for whom psychological interventions could improve birth experience.
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Affiliation(s)
- Pauline Slade
- Department of Primary Care and Mental Health, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Kayleigh Sheen
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Andrew Weeks
- Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, UK
| | - Susan Wray
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Leonardo De Pascalis
- Psychological Sciences, Institute of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Karen Lunt
- Department of Midwifery, Child and Reproductive Health, University of Chester, Chester, UK
| | - Carol Bedwell
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Johnathan Hill
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Helen Sharp
- Department of Primary Care and Mental Health, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
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20
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Vázquez MB, Míguez MC. Spanish Brief Version of the Pregnancy Related Anxiety Questionnaire: PRAQ-20. CLÍNICA Y SALUD 2021. [DOI: 10.5093/clysa2020a22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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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: 12] [Impact Index Per Article: 3.0] [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.
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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
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22
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Brunton R, Wood T, Dryer R. Childhood abuse, pregnancy-related anxiety and the mediating role of resilience and social support. J Health Psychol 2020; 27:868-878. [DOI: 10.1177/1359105320968140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Physical, sexual and psychological abuse were examined as risk factors for pregnancy-related anxiety with resilience and social support as mediators. Pregnant women ( n = 638) completed measures of pregnancy-related anxiety, resilience, perceived social support and childhood abuse. Women with an abuse history had higher pregnancy-related anxiety scores ( m = 64.40) than other women ( m = 55.36). All abuse types independently predicted pregnancy-related anxiety; resilience and social support were mediators. Results highlight the value of antenatal screening for pregnancy-related anxiety including specific risk factors such as child abuse. Programs such as the Midwife Continuity of Care are useful in encouraging disclosure.
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Naja S, Al Kubaisi N, Singh R, Bougmiza I. Generalized and pregnancy-related anxiety prevalence and predictors among pregnant women attending primary health care in Qatar, 2018-2019. Heliyon 2020; 6:e05264. [PMID: 33134579 PMCID: PMC7586091 DOI: 10.1016/j.heliyon.2020.e05264] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/14/2020] [Accepted: 10/12/2020] [Indexed: 12/28/2022] Open
Abstract
Background Cumulative evidence suggests that early identification of anxiety in pregnancy is important, given that antenatal anxiety has been linked to morbid outcomes in expecting mothers and their offspring. However, the burden of antenatal anxiety is not yet known in Qatar. This research aims to measure the prevalence and determinants of generalized and pregnancy-related anxiety among pregnant women. Methods Eight hundred pregnant women completed a structured interview and self-administrated questionnaires after being selected through probability sampling from nine primary healthcare centers distributed across Qatar. We subjected the data to Binary and Multiple Logistic Regression Analysis. Furthermore, we conducted a Confirmatory Factor Analysis for the utilized scales. Results Out of eight hundred participants, 26.5% reported high pregnancy-related anxiety, while 16.4% had a generalized anxiety disorder. A high level of perceived social support and resilience was shown to mitigate generalized and pregnancy-related anxiety. However, we revealed that different determinants influence the two types of anxiety. Limitations There is no recognized optimal cut-off point to distinguish ‘high risk’ in pregnancy-related anxiety scales. Conclusions Pregnancy-related anxiety is more prevalent than generalized anxiety among pregnant women in Qatar, indicating that stakeholders must include screening for pregnancy-related anxiety in Qatar's clinical guidelines. Tailored interventional studies could focus on increasing resilience and social support to decrease the burden of antenatal anxiety.
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Affiliation(s)
| | | | - Rajvir Singh
- Biostatistics, Hamad Medical Corporation, Doha, Qatar
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Dellagiulia A, Lionetti F, Pastore M, Linnea K, Hasse K, Huizink AC. The Pregnancy Anxiety Questionnaire Revised-2. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2020. [DOI: 10.1027/1015-5759/a000559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Pregnancy-related anxiety is an important risk factor for adverse pregnancy outcomes and postnatal parental well-being, to a greater extent than general anxiety, calling for a reliable and validated measure for its assessment. The current paper aimed to validate the Pregnancy Anxiety Questionnaire – Revised-2 (PRAQ-R2; Huizink et al., 2016 ) in a sample of Italian women, by testing its psychometric properties, and checking for Italian–Finnish measurement invariance. Additionally, the association with general anxiety and depression was examined. Participants included 348 Italian pregnant women and 348 Finnish pregnant women. Results showed that the Italian version of PRAQ-R2 presents satisfying psychometric proprieties. Data supported a three-factor solution including fear of giving birth, w orries about bearing a handicapped child, and concern about own appearance. Invariance across countries was confirmed. The primiparous condition was associated with a higher level of pregnancy anxiety only for fear of giving birth. A moderate correlation was found between pregnancy anxiety and general anxiety and depression, providing evidence for concurrent validity, as well as for the existence of a specific pregnancy anxiety dimension.
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Affiliation(s)
- Antonio Dellagiulia
- Department of Psychology, School of Educational Sciences, Salesian University of Rome, Italy
| | - Francesca Lionetti
- Department of Biological and Experimental Psychology, Queen Mary University of London, UK
| | | | - Karlsson Linnea
- Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, FinnBrain Birth Cohort Study, Turku, Finland
- Department of Child Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
- Department of Clinical Medicine, Centre for Population Health Research University of Turku and Turku University Hospital, Turku, Finland
| | - Karlsson Hasse
- Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, FinnBrain Birth Cohort Study, Turku, Finland
- Department of Clinical Medicine, Centre for Population Health Research University of Turku and Turku University Hospital, Turku, Finland
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Anja C. Huizink
- Section Clinical Developmental Psychology, Faculty of Behavioral and Movement Sciences, VU University Amsterdam, The Netherlands
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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: 17] [Impact Index Per Article: 4.3] [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.
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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
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Reduction in physical activity significantly increases depression and anxiety in the perinatal period: a longitudinal study based on a self-report digital assessment tool. Arch Gynecol Obstet 2020; 302:53-64. [PMID: 32372342 DOI: 10.1007/s00404-020-05570-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 04/25/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Physical activity can reduce pregnancy-related complications and contributes substantially to improving maternal mental health. A reduction in activity encompassing exercise and daily household tasks throughout the course of pregnancy increases the risk of depression and anxiety. The following research examines the longitudinal interaction between exercise, general physical activity, and mental health outcomes in pregnant women. METHODS This prospective longitudinal study was conducted at the maternity departments of two major university hospitals in Germany. Self-reported data of 597 women were digitally assessed every 4 weeks from the second trimester until birth as well as 3 and 6 months postnatally. Depressive and anxiety symptoms were assessed using the EPDS, PRAQ, and STAI and physical activity levels were measured using the PPAQ questionnaire. Cross-sectional and longitudinal analyses using Pearson's correlation coefficient and multiple regression models were conducted. RESULTS We found a significant reduction in general physical activity in the period from the 20th to 32nd gestational week. Women who reported a greater decline during pregnancy showed significantly higher depression and anxiety scores. In stratified analyses, only baseline mental health scores proved to be variables with stronger impact on postnatal depression and anxiety outcomes. CONCLUSION General physical activity and maternal mental health significantly influence each other during and after pregnancy. Both physical activity and the prevention of perinatal mental disorders should be systematically encouraged during perinatal care to prevent adverse maternal and fetal birth outcomes.
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Maria A, Nissilä I, Shekhar S, Kotilahti K, Tuulari JJ, Hirvi P, Huotilainen M, Heiskala J, Karlsson L, Karlsson H. Relationship between maternal pregnancy-related anxiety and infant brain responses to emotional speech - a pilot study. J Affect Disord 2020; 262:62-70. [PMID: 31710930 DOI: 10.1016/j.jad.2019.10.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/09/2019] [Accepted: 10/28/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Maternal pregnancy-related anxiety (PRA) is reportedly related to neurodevelopmental outcomes of infants. However, the relationship between maternal PRA and the processing of emotions in the infant brain has not been extensively studied with neuroimaging. The objective of the present pilot study is to investigate the relationship between maternal PRA and infant hemodynamic responses to emotional speech at two months of age. METHODS The study sample included 19 mother-infant dyads from a general sample of a population of Caucasian mothers. Self-reported Pregnancy-Related Anxiety Questionnaire (PRAQ-R2) data was collected from mothers during pregnancy at gestational weeks (gwks) 24 (N = 19) and 34 (N = 18). When their infants were two months old, the infants' brains functional responses to emotional speech in the left fronto-temporoparietal cortex were recorded using diffuse optical tomography (DOT). RESULTS Maternal PRAQ-R2 scores at gwk 24 correlated negatively with the total hemoglobin (HbT) responses to sad speech on both sides of the temporoparietal junction (Spearman's rank correlation coefficient ρ = -0.87). The correlation was significantly greater at gwk 24 than gwk 34 (ρ = -0.42). LIMITATIONS The field of view of the measurement did not include the right hemisphere or parts of the frontal cortex. The sample size is moderate and the mothers were relatively highly educated, thus there may be some differences between the study sample and the general population. CONCLUSIONS Maternal pregnancy-related anxiety may affect child brain emotion processing development. Further research is needed to understand the functional and developmental significance of the findings.
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Affiliation(s)
- Ambika Maria
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland
| | - Ilkka Nissilä
- Aalto University, Department of Neuroscience and Biomedical Engineering, Finland.
| | - Shashank Shekhar
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland; University of Mississippi Medical Center, Department of Neurology, MS, USA
| | - Kalle Kotilahti
- Aalto University, Department of Neuroscience and Biomedical Engineering, Finland
| | - Jetro J Tuulari
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland; The Turku Collegium for Science and Medicine (TCSM); University of Oxford, Department of Psychiatry, Oxford, United Kingdom; University of Turku and Turku University Hospital, Department of Psychiatry, Turku, Finland
| | - Pauliina Hirvi
- Aalto University, Department of Neuroscience and Biomedical Engineering, Finland; Aalto University, Department of Mathematics and Systems Analysis, Finland
| | - Minna Huotilainen
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland; University of Helsinki, Faculty of Educational Sciences, CICERO Learning, Finland
| | - Juha Heiskala
- Helsinki University Central Hospital, Department of Clinical Neurophysiology, Finland
| | - Linnea Karlsson
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland; University of Turku and Turku University Hospital, Department of Child Psychiatry, Turku, Finland
| | - Hasse Karlsson
- University of Turku, Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland; University of Turku and Turku University Hospital, Department of Psychiatry, Turku, Finland
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Göbel A, Arck P, Hecher K, Schulte-Markwort M, Diemert A, Mudra S. Manifestation and Associated Factors of Pregnancy-Related Worries in Expectant Fathers. Front Psychiatry 2020; 11:575845. [PMID: 33362598 PMCID: PMC7759496 DOI: 10.3389/fpsyt.2020.575845] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022] Open
Abstract
Background: During the last decades, fathers have increasingly participated in prenatal care, birth preparation classes, and childbirth. However, comparably little is known about the prenatal emotional well-being of fathers, particularly content and extent of broader paternal concerns that may arise during pregnancy beyond those focusing on childbirth. Thus, the aims of this study were to investigate the manifestation of paternal pregnancy-related worries in a population-based sample and to identify relevant associated factors. Materials and Methods: As part of a longitudinal pregnancy cohort at the University Medical Center Hamburg-Eppendorf, Germany, N = 129 expectant fathers were assessed once during pregnancy. Pregnancy-related worries centering around medical procedures, childbirth, health of the baby, as well as socioeconomic aspects were assessed with the Cambridge Worry Scale (CWS). Additionally, paternal socioeconomic background and maternal obstetrical history, symptoms of generalized anxiety and depression, and level of hostility were investigated, as well as perceived social support. The cross-sectional data were analyzed based on multiple regression analyses. Results: The level of reported worries was overall low. Some fathers reported major worries for individual aspects like the health of a significant other (10.9%) and the baby (10.1%), as well as the current financial (6.2%) and employment situation (8.5%). Pregnancy-related worries were negatively associated with household income and positively associated with anxious and depressive symptoms and low perceived social support. Associations varied for specific pregnancy-related worries. Limitations: Due to the cross-sectional data examined in this study, a causal interpretation of the results is not possible. The sample was rather homogeneous regarding its socioeconomic background. More research needs to be done in larger, more heterogeneous samples. Conclusion: Though overall worries were rather low in this sample, specific major worries could be identified. Hence, addressing those fathers reporting major worries regarding specific aspects already in prenatal care might support their psychosocial adjustment. Fathers with little income, those with elevated levels of general anxious and depressive symptoms, and those with less social support reported higher pregnancy-related worries. Our results indicate the relevance of concerns beyond health- and birth-related aspects that could be relevant for fathers. Measurements developed specifically for expectant fathers are needed to properly capture their perspective already during pregnancy.
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Affiliation(s)
- Ariane Göbel
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petra Arck
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Schulte-Markwort
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anke Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Mudra
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Maternal-fetal attachment protects against postpartum anxiety: the mediating role of postpartum bonding and partnership satisfaction. Arch Gynecol Obstet 2019; 301:107-117. [PMID: 31875254 DOI: 10.1007/s00404-019-05402-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/25/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Maternal mental disorders develop frequently during the perinatal period, and can have detrimental effects on the developing bond between a mother and her child. While depression has already been widely associated with bonding disorders, the link between anxiety disorders and maternal-fetal attachment has received only limited attention. This study aimed to explore the link between maternal-fetal attachment in the third trimester and postpartum anxiety, as previous research has suggested a potentially protective association. Additionally, we hypothesized a mediating influence of postpartum bonding and partnership satisfaction as additional measurements of attachment capacity. METHODS Self-report questionnaires assessing maternal-fetal attachment, postpartum bonding, anxiety, depression, and partnership quality were completed at three time points: third trimester (T1, N = 324), first week postpartum (T2, N = 249), and 4 months postpartum (T3, N = 166). Conditional process analyses were used to test for mediation. RESULTS A statistically significant negative correlation of maternal-fetal attachment was found with maternal anxiety postpartum. Overall, the analyses supported the mediation hypothesis. There was a significant, indirect effect of maternal-fetal attachment during pregnancy on state anxiety in the first week postpartum, mediated through postpartum bonding quality and partnership satisfaction. All three variables together accounted for 18.25% (state anxiety) or 30.35% (trait anxiety) of the variance in postpartum anxiety. CONCLUSIONS Our results showed that a close maternal-fetal attachment buffers postpartum symptoms of anxiety, partially mediated through postpartum bonding and partnership satisfaction. Therefore, strengthening the maternal-fetal attachment and the partnership during pregnancy has the potential to reduce maternal postpartum symptoms of anxiety.
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Jones SMW, Du Y, Panattoni L, Henrikson NB. Assessing Worry About Affording Healthcare in a General Population Sample. Front Psychol 2019; 10:2622. [PMID: 31824388 PMCID: PMC6883904 DOI: 10.3389/fpsyg.2019.02622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/06/2019] [Indexed: 11/20/2022] Open
Abstract
This study adapted a measure on worry about affording healthcare. The financial costs of healthcare are increasingly being shifted to patients. Financial burden from healthcare costs can be material (such as bankruptcy) or psychological. Psychological distress can be either worry about affording future care or distress due to material consequences and, despite evidence from clinical psychology that differentiates these types of emotional symptoms, this distinction has largely been ignored for financial burden in healthcare. We adapted a worry about affording healthcare scale for use in the general population (n = 398) to facilitate comparisons between disease groups and across countries. Participants completed a survey through an online platform. The worry about affording healthcare measure showed good reliability and validity through associations with quality of life (QOL) and measures of other types of financial burden. Worry about affording healthcare was also associated with cost-related non-adherence to medical care. Future research on patient QOL should consider worry about affording healthcare.
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Affiliation(s)
- Salene M W Jones
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Yuxian Du
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States.,Bayer Healthcare U.S. LLC, Whippany, NJ, United States
| | - Laura Panattoni
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
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The characteristics and prevalence of phobias in pregnancy. Midwifery 2019; 82:102590. [PMID: 31864080 DOI: 10.1016/j.midw.2019.102590] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 10/20/2019] [Accepted: 11/27/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The primary objective was to estimate the population prevalence of specific phobias (including pregnancy related specific phobias) and associated mental disorders. The secondary objective was to investigate the effectiveness of routinely collected screening tools (depression and anxiety screens, Whooley and GAD-2 respectively) in identifying specific phobias. Specific phobias are the most common anxiety disorder to occur during pregnancy, but studies on prevalence and clinical correlates of specific phobias, including pregnancy related specific phobias are lacking. DESIGN Cross-sectional survey using a two-phase sampling design stratified according to being positive or negative on the Whooley questions routinely asked by midwives. Approaching all whooley positive women and drawing a random sample of Whooley negative women. Sampling weights were used to account for the bias induced by the stratified sampling. PARTICIPANTS 545 pregnant women attending their first antenatal appointment. Language interpreters were used where required. SETTING Inner-city maternity service, London, UK. MEASUREMENTS The Structured Clinical Interview for DSM-IV Axis I Mental Disorders were administered to assess mental disorders and 544 women responded to the anxiety module on specific phobias. RESULTS The maternity population prevalence estimate for specific phobias was 8.4% (95%CI: 5.8-12.1%) and for pregnancy related phobias was 1.5% (95%CI: 0.6-3.7%), most of which were needle phobias. The prevalence estimate of tokophobia was 0.032% (95%CI: 0.0044-0.23%). Over half (52.4%) the women with specific phobias had comorbid mental disorders. Routinely administered screening tools (Whooley and GAD-2) were not helpful in identifying phobias. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Phobias in pregnancy are common but pregnancy related phobias are rare, particularly tokophobia. As routinely administered screening tools were not helpful in identifying phobias, other indicators could be considered, such as avoidance of blood tests and requests for caesarean sections.
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Axfors C, Eckerdal P, Volgsten H, Wikström AK, Ekselius L, Ramklint M, Sundström Poromaa I, Skalkidou A. Investigating the association between neuroticism and adverse obstetric and neonatal outcomes. Sci Rep 2019; 9:15470. [PMID: 31664086 PMCID: PMC6820798 DOI: 10.1038/s41598-019-51861-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/04/2019] [Indexed: 11/13/2022] Open
Abstract
Neuroticism is not only associated with affective disorders but also with certain somatic health problems. However, studies assessing whether neuroticism is associated with adverse obstetric or neonatal outcomes are scarce. This observational study comprises first-time mothers (n = 1969) with singleton pregnancies from several cohorts based in Uppsala, Sweden. To assess neuroticism-related personality, the Swedish universities Scales of Personality was used. Swedish national health registers were used to extract outcomes and confounders. In logistic regression models, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for the outcomes by an increase of 63 units of neuroticism (equalling the interquartile range). Analyses were adjusted for maternal age, educational level, height, body mass index, year of delivery, smoking during pregnancy, involuntary childlessness, and psychiatric morbidity. Main outcomes were mode of delivery, gestational diabetes mellitus, gestational hypertension, preeclampsia, induction of delivery, prolonged delivery, severe lacerations, placental retention, postpartum haemorrhage, premature birth, infant born small or large for gestational age, and Apgar score. Neuroticism was not independently associated with adverse obstetric or neonatal outcomes besides gestational diabetes. For future studies, models examining sub-components of neuroticism or pregnancy-specific anxiety are encouraged.
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Affiliation(s)
- Cathrine Axfors
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Patricia Eckerdal
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Helena Volgsten
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna-Karin Wikström
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Lisa Ekselius
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Mia Ramklint
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | | | - Alkistis Skalkidou
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Mediating Role of Labor on the Relationship Between Prenatal Psychopathologic Symptoms and Symptoms of Postpartum Depression in Women Who Give Birth Vaginally. J Obstet Gynecol Neonatal Nurs 2019; 48:627-634. [PMID: 31626779 DOI: 10.1016/j.jogn.2019.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To investigate how prenatal symptoms of anxiety and depression and clinical aspects of labor (duration of labor, administration of oxytocin and epidural analgesia) interact with each other to contribute to symptoms of postpartum depression in women who give birth vaginally. DESIGN A longitudinal design with measurement at three different time points: Time 1, 31 to 32 weeks gestation; Time 2, the day of labor and birth; and Time 3, 1 month after birth. SETTING Maternity ward of the Misericordia e Dolce Hospital in Prato, Italy. PARTICIPANTS A total of 186 women at 31 to 32 weeks gestation were recruited during childbirth preparation courses at the maternity ward. METHODS At Time 1, women completed the Beck Depression Inventory and the State portion of the State-Trait Anxiety Inventory. At Time 2, midwives recorded clinical data related to labor, including duration of labor and administration of oxytocin and epidural analgesia. At Time 3, the women completed the Edinburgh Postnatal Depression Scale. Structural equation modeling was performed. RESULTS Symptoms of depression (β = 0.36; p < .001; 95% confidence interval [CI] [0.17, 0.49]) and state anxiety (β = 0.25; p < .001; 95% CI = [0.04, 0.27]) during pregnancy positively affected symptoms of depression after birth. Greater levels of these prenatal symptoms predicted a more complicated labor (depression: β = 0.29; p < .01; 95% CI [0.00, 0.19]; anxiety: β = 0.30; p < .01; 95% CI [0.01, 0.14]), which, in turn, positively predicted greater levels of symptoms of depression at 1 month after birth (β = 0.34; p < .001; 95% CI [0.38, 1.51]). Moreover, results highlighted indirect effects that high levels of anxiety symptoms during pregnancy have on postpartum symptoms of depression through the clinical aspects of labor (β = 0.10; p < .01; 95% CI [0.00, 0.13]). These indirect effects were not significant for antenatal symptoms of depression (β = 0.10; p < .05; 95% CI [-0.02, 0.20]). CONCLUSION Our findings confirm that symptoms of anxiety and depression during pregnancy represent significant risk factors for the clinical aspects of labor and for the development of symptoms of postpartum depression in the first month after childbirth.
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Dissatisfaction with the husband support increases childbirth fear among Indonesian primigravida. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Dere SS, Varotariya JK, Ghildiyal RP, Sharma SA, Kaur DMS. Antenatal preparedness for motherhood and its association with antenatal anxiety and depression in first time pregnant women from India. Ind Psychiatry J 2019; 28:255-261. [PMID: 33223720 PMCID: PMC7659993 DOI: 10.4103/ipj.ipj_66_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 04/26/2020] [Accepted: 06/04/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIMS Pregnancy is a developmental period demanding special adjustments. Psychologically, pregnancy can be associated with positive preparedness in some and fear of childbirth or doubts of mothering role in others. Anxiety and depression during pregnancy can have negative implications on its outcome. The current study aims to provide insight into factors influencing maternal preparedness for motherhood. METHODOLOGY Hundred first time pregnant women were enrolled after written informed consent and ethical approval. The Pregnancy Experiences Scale-Brief Version was used to study maternal rating of uplifts and hassles experiences specific to pregnancy, indicating affective valence toward the pregnancy. Pregnancy-Related Anxiety Questionnaire (PRAQ-R) helped to identify pregnancy-specific anxiety and depressive symptoms were screened using Whooley's Questions. Data were analyzed using Microsoft Excel 15.30 (170107). RESULTS The mean age of the women was 23.1 years. More than half of the pregnancies were unplanned, and the mean duration of pregnancy was 6.8 months. The positive experience was reported more than a negative experience. Negative valence increased in the presence of psychosocial stressors. On PRAQ-R, anxiety symptoms were reported by 52% of the patients, especially high on the domain of "fear of giving birth" and increased with trimester. Depressive symptoms were reported by 23% of the women. CONCLUSION Advanced gestation, presence of stressors, past psychiatric illness, ANC complications, and the presence of anxiety/depression influence maternal preparedness for motherhood. There is a need of sensitizing the doctors, nurses, health-care workers, and relatives regarding screening, referral of unmet psychological needs of pregnant women to help new mothers to adjust with their motherhood positively.
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Affiliation(s)
| | - Jagdish K Varotariya
- Department of Psychiatry, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India
| | - Rakesh P Ghildiyal
- Department of Psychiatry, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India
| | - Sunil A Sharma
- Department of Obstetrics and Gynaecology, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India
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Nasreen HE, Pasi HB, Rifin SM, Aris MAM, Rahman JA, Rus RM, Edhborg M. Impact of maternal antepartum depressive and anxiety symptoms on birth outcomes and mode of delivery: a prospective cohort study in east and west coasts of Malaysia. BMC Pregnancy Childbirth 2019; 19:201. [PMID: 31200677 PMCID: PMC6567652 DOI: 10.1186/s12884-019-2349-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 05/31/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antepartum depressive and anxiety symptoms (ADS and AAS) are prevalent in Malaysia. Prior evidence linking maternal ADS and AAS with adverse birth outcomes and caesarean section (CS) or instrumental delivery is conflicting. There is no research in Malaysia on the association between maternal mental disorders and adverse birth outcomes and mode of delivery. This study aims to investigate the independent effect of maternal ADS and AAS on low birth weight (LBW), preterm birth (PTB) and CS or instrumental delivery among women in east and west coasts of Malaysia. METHODS We used data from a prospective cohort study of 799 pregnant women from health clinics of two states in east and west coasts of Malaysia. Baseline data were measured at the third trimester of pregnancy on ADS, AAS, socioeconomic condition, anthropometric status, reproductive history and intimate partner violence. Birth outcomes and mode of delivery were determined at the time of delivery. Univariate and multiple Cox's regressions were applied to assess the association between ADS and AAS and LBW, PTB and CS or instrumental delivery. RESULTS ADS was significantly associated with an increased risk of giving birth to LBW babies in both east coast (RR = 3.64; 95% CI 1.79-7.40) and west coast (RR = 3.82; 95% CI 1.86-7.84), but not with PTB. AAS was associated with increased risk of both LBW (RR = 2.47; 95% CI 1.39-4.38) and PTB (RR = 2.49; 95% CI 1.16-5.36) in the east coast, but not in west coast. The risk of CS or instrumental delivery was evident among women with ADS (RR = 2.44; 95% CI 1.48-4.03) in west coast only. CONCLUSION ADS predicts LBW in both coasts, AAS predicts LBW and PTB in east coast, and ADS predicts CS or instrumental delivery in west coast. Policies aimed at detection and management of ADS and AAS during antenatal check-up in health clinics may help improve birth outcomes and reduce obstetric interventions.
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Affiliation(s)
- Hashima E. Nasreen
- Department of Community Medicine, Faculty of Medicine, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang Malaysia
| | - Hafizah Binti Pasi
- Department of Community Medicine, Faculty of Medicine, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang Malaysia
| | - Sakinah Md Rifin
- Department of Family Medicine, Faculty of Medicine, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang Malaysia
| | - Mohd Aznan Md Aris
- Department of Family Medicine, Faculty of Medicine, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang Malaysia
| | - Jamalludin Ab Rahman
- Department of Community Medicine, Faculty of Medicine, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang Malaysia
| | - Razman Mohd Rus
- Department of Community Medicine, Faculty of Medicine, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang Malaysia
| | - Maigun Edhborg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, SE-141 83 Huddinge, Stockholm, Sweden
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Uçar T, Golbasi Z. Effect of an educational program based on cognitive behavioral techniques on fear of childbirth and the birth process. J Psychosom Obstet Gynaecol 2019; 40:146-155. [PMID: 29583056 DOI: 10.1080/0167482x.2018.1453800] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Objective: This study determined the effect of an educational program based on cognitive behavioral techniques (CBT) provided for pregnant women to address their fear of childbirth. Methods: This study was conducted experimentally using pretest-posttest and a control group. A total of 111 Turkish pregnant women were recruited with 52 in the intervention group and 59 in the control group. The intervention group attended the educational program on coping with childbirth fears based on CBT, which took 3 weeks over six sessions. The Wijma Delivery Expectancy/Experience Questionnaire, version-A (W-DEQ-A) was administered to both groups as the posttest. The researchers monitored the pregnant women's labor and delivery and the State Anxiety Inventory (SAI), Numeric Pain Rating Scale (NPRS) and Birth Process Evaluation Form were completed. Results: The post-education W-DEQ-A score was 63.5 in the control group and 39.4 in the intervention group (p < .001). Their labor pain was lower, the second stage of labor was shorter and birth was more satisfactory for the intervention group than for the control group (p < .05). The CBT-based educational program and pain severity during childbirth were the significant predictors of satisfaction with childbirth (β = 0.354; β = -0.324, respectively; p < .05 for all). Conclusions: The CBT-based educational program on coping with childbirth fears reduced pregnant women's fear of childbirth and positively affected their birth experience.
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Affiliation(s)
- Tuba Uçar
- a Department of Midwifery , İnönü University , Malatya , Turkey
| | - Zehra Golbasi
- b Department of Nursing , Cumhuriyet University , Sivas , Turkey
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Sun Y, Huang K, Hu Y, Yan S, Xu Y, Zhu P, Tao F. Pregnancy-specific anxiety and elective cesarean section in primiparas: A cohort study in China. PLoS One 2019; 14:e0216870. [PMID: 31091276 PMCID: PMC6519904 DOI: 10.1371/journal.pone.0216870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/30/2019] [Indexed: 01/17/2023] Open
Abstract
The purpose of this study was to investigate the association between pregnancy-specific anxiety and elective cesarean section, and identify the critical period in which pregnancy-specific anxiety will affect the elective cesarean section. Primiparous women in the 1st trimester of pregnancy were invited to participate in the cohort. General information on maternal socio-demographic characteristics and environmental exposure were collected using questionnaires. Pregnancy-specific anxiety was assessed by using pregnancy-specific anxiety questionnaire in the 1st, 2nd and 3rd trimester, respectively. Delivery modes and pregnancy complications were abstracted from medical notes. Structural equation modeling (SEM) was adopted to examine the relationship between pregnancy-specific anxiety and elective cesarean section. Results indicated the overall elective cesarean section rate in this study was 45%. Among 1 874 pregnant women, 30.9% women experienced anxiety at least once during pregnancy, and 6.9% women suffered from anxiety in all three trimesters. Anxiety in the 2nd trimester was a significant predictor for elective cesarean section. Young maternal age and low educational level had indirect effects on women’s choice of elective caesarean section through affecting pregnancy-specific anxiety. More attention should be paid to maternal psychological problems, and professional counseling needs to be strengthened to protect women from pregnancy-specific anxiety.
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Affiliation(s)
- Yuanfang Sun
- Department of Maternal, Child and Adolescent Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, Anhui Medical University, Hefei, Anhui Province, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, Anhui Province, China
- * E-mail:
| | - Yabin Hu
- Department of Maternal, Child and Adolescent Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Shuangqin Yan
- Ma'anshan Maternal and Child Health Center, Ma'anshan, China
| | - Yeqing Xu
- Ma'anshan Maternal and Child Health Center, Ma'anshan, China
| | - Peng Zhu
- Department of Maternal, Child and Adolescent Health, Anhui Medical University, Hefei, Anhui Province, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, Anhui Province, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, Anhui Medical University, Hefei, Anhui Province, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, Anhui Province, China
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Rondung E, Ekdahl J, Sundin Ö. Potential mechanisms in fear of birth: The role of pain catastrophizing and intolerance of uncertainty. Birth 2019; 46:61-68. [PMID: 29954044 DOI: 10.1111/birt.12368] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although many pregnant women experience fear, worry, or anxiety relating to the upcoming birth, little is known regarding the psychological mechanisms contributing to these experiences. In this study, we wanted to take a first step in trying to identify mechanisms of potential interest. The objective of this cross-sectional study was thus to investigate pain catastrophizing, intolerance of uncertainty, positive worry beliefs, and cognitive avoidance as potential mechanisms predicting fear of birth among pregnant women. METHODS A sample of 499 pregnant women, recruited in antenatal health care settings in 2 Swedish regions, completed the Fear of Birth Scale, along with measurements of the mechanisms of interest. Linear and logistic hierarchical regression analyses were used to investigate the extent to which pain catastrophizing, intolerance of uncertainty, positive worry beliefs, and cognitive avoidance predicted fear of birth, both as a continuous and a dichotomous measure. RESULTS Logistic regression analysis showed high levels of pain catastrophizing and intolerance of uncertainty to be the best predictors of fear of birth, OR 3.49 (95% CI 2.17-5.61) and OR 3.25 (95% CI 2.00-5.27), respectively. Positive beliefs about worry and cognitive avoidance were both correlated with fear of birth as a continuous measure, but did not contribute to the logistic regression model. CONCLUSIONS Pain catastrophizing and intolerance of uncertainty were the most evident predictors of fear of birth. Although preliminary, the findings suggest that interventions targeting catastrophic cognitions and intolerance of uncertainty might be relevant to psychological treatment for fear, worry, or anxiety relating to giving birth.
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Affiliation(s)
- Elisabet Rondung
- Department of Psychology, Mid Sweden University, Östersund, Sweden
| | - Johanna Ekdahl
- Department of Psychology, Mid Sweden University, Östersund, Sweden
| | - Örjan Sundin
- Department of Psychology, Mid Sweden University, Östersund, Sweden
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Irmak Vural P, Aslan E. Emotional freedom techniques and breathing awareness to reduce childbirth fear: A randomized controlled study. Complement Ther Clin Pract 2019; 35:224-231. [PMID: 31003663 DOI: 10.1016/j.ctcp.2019.02.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Emotional freedom techniques (EFT) and breathing awareness (BA) are applicable during labour. The present study aimed to determine the effectiveness of EFT and BA in the reduction of childbirth fear. MATERIALS AND METHODS This randomized controlled study included 120 pregnant women, of whom the EFT, BA and control groups. The women in the EFT and BA groups were offered their intervention in the latent, active and transition phases of labour. RESULTS There was no significant difference in the sociodemographic and obstetric factors between the groups (p > 0.05). The Subjective Units of Distress Scale in active and transition phases were significantly lower in the EFT group. The difference in the scores for the Wijma Delivery Expectancy/Experience Questionnaire (version B) between the groups was significant (p < 0.001). CONCLUSION Both EFT and BA were observed to be beneficial in clinical practice; the EFT was found to be more effective and permanent.
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Affiliation(s)
- Pınar Irmak Vural
- Istanbul Medipol University, Health Science Faculty, Department of Nursing, Ekinciler Street Nu.19 Kavacık, Beykoz, 34810, Istanbul, Turkey.
| | - Ergül Aslan
- Istanbul University-Cerrahpasa, Florence Nightingale Faculty of Nursing, Department of Women Health and Gynecologic Nursing, Abide-i Hürriyet Street, 34381, Şişli, Istanbul, Turkey.
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Wallwiener S, Goetz M, Lanfer A, Gillessen A, Suling M, Feisst M, Sohn C, Wallwiener M. Epidemiology of mental disorders during pregnancy and link to birth outcome: a large-scale retrospective observational database study including 38,000 pregnancies. Arch Gynecol Obstet 2019; 299:755-763. [PMID: 30734864 DOI: 10.1007/s00404-019-05075-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 01/31/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE To investigate the real-life epidemiology of mental disorders during pregnancy and their impact on birth outcome in an unselected low-risk population in Germany. METHODS Claims data of the Techniker Krankenkasse (TK) were analyzed as part of a retrospective observational study over a one-year period from 01/2008 to 12/2008 including 38,174 pregnant women. ICD-10 codes were clustered into four diagnostic groups: depression, anxiety disorders, somatoform/dissociative disorders and acute stress reactions. The relationship between mental disorders, birth mode and infant weight was tested using chi-squared tests and multivariate logistic regression. Main outcome measures included the prevalence of mental disorders during pregnancy, performed cesarean sections and infants born underweight. RESULTS N = 16,639 cases with at least one diagnosis from the four mental disorder diagnostic groups were identified: 9.3% cases of depression, 16.9% cases with an anxiety disorder, 24.2% cases with a somatoform/dissociative disorder, and 11.7% cases of acute stress reactions. Women diagnosed with a mental disorder were more likely to deliver their child by cesarean section ([depression: OR =1.26 (95% CI 1.14-1.39); anxiety: OR 1.11 (95% CI 1.02-1.19); somatoform disorders: OR 1.12 (95% CI 1.05-1.20); acute stress reactions: OR 1.17 (95% CI 1.07-1.28)]. Furthermore, infants of women diagnosed with an ICD-10 code for depression during pregnancy were more likely to be underweight and/or delivered preterm [OR =1.34 (95% CI 1.06-1.69)]. CONCLUSIONS We observed substantially high prevalence rates of mental disorders during pregnancy which urgently warrant more awareness for validated screening and adequate treatment options.
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Affiliation(s)
- Stephanie Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
| | - Maren Goetz
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Anne Lanfer
- Techniker Krankenkasse, Bramfelder Str. 140, 22305, Hamburg, Germany
| | - Andrea Gillessen
- Techniker Krankenkasse, Bramfelder Str. 140, 22305, Hamburg, Germany
| | - Marc Suling
- Techniker Krankenkasse, Bramfelder Str. 140, 22305, Hamburg, Germany
| | - Manuel Feisst
- Institute of Medical Biometry and Informatics, University of Heidelberg, 69120, Heidelberg, Germany
| | - Christof Sohn
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
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Jones SMW, Nguyen T, Chennupati S. Association of Financial Burden With Self-Rated and Mental Health in Older Adults With Cancer. J Aging Health 2019; 32:394-400. [PMID: 30698482 DOI: 10.1177/0898264319826428] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objective: Financial problems in cancer survivors are associated with distress and reduced quality of life. Most studies have been cross-sectional, and a longitudinal study is needed to guide clinical interventions. Method: We used data from two surveys of the National Health and Aging Trends Study (NHATS). Participants (n = 307) reported whether they experienced six indicators of financial burden. The Patient Health Questionnaire 4 assessed depressive symptoms and general anxiety. Cross-lagged panel analyses assessed whether financial burden predicted distress and health or vice versa. Results: In the total sample, financial burden at the first survey predicted depressive symptoms (p < .01), general anxiety (p < .01), and self-rated health (p < .01) at the second survey. Depressive symptoms, general anxiety, and self-rated health at the first survey did not predict later financial burden (ps > .05). Discussion: Results suggest financial problems predict later distress and poor health. This study highlights the need to address financial burden in cancer survivors.
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Affiliation(s)
| | - Trung Nguyen
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Psychometric Properties of the Spanish Version of the Pregnancy Related Anxiety Questionnaire (PRAQ). SPANISH JOURNAL OF PSYCHOLOGY 2018; 21:E64. [PMID: 30501656 DOI: 10.1017/sjp.2018.67] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although pregnancy increases the vulnerability to anxiety, no specific assessment instruments are usually used to detect it. The objective of this study was to adapt the Pregnancy Related Anxiety Questionnaire (PRAQ) to Spanish population, as well as analyze its validity and reliability. A sample of 367 nulliparous pregnant women with a normal risk status filled in a socio-demographic and obstetric-gynaecological questionnaire, the PRAQ, the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI). After performing a factorial analysis, a five-factor model that explains 53.1% of the variance was obtained. Estimates of internal consistency reliability were adequate (range = .78 to .93) for the five factors included in the final confirmatory factor analysis, and for the total scale (.97). Significant correlation among PRAQ, EPDS, and STAI was found (p < .001). The 85th percentile (score 234 or more) was used as a cut-off point to identify those women with high pregnancy-specific anxiety. In accordance with the results obtained, the PRAQ can be considered a useful screening tool to evaluate pregnancy-related anxiety among the Spanish population.
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Rondung E, Ekdahl J, Hildingsson I, Rubertsson C, Sundin Ö. Heterogeneity in childbirth related fear or anxiety. Scand J Psychol 2018; 59:634-643. [DOI: 10.1111/sjop.12481] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 07/05/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Ingegerd Hildingsson
- Department of Women′s and Children′s Health, Obstetrics and Gynecology; Uppsala University; Sweden
- Department of Nursing; Mid Sweden University; Sweden
| | - Christine Rubertsson
- Department of Women′s and Children′s Health, Obstetrics and Gynecology; Uppsala University; Sweden
- Department of Health Sciences; Faculty of Medicine; Lund University; Sweden
| | - Örjan Sundin
- Department of Psychology; Mid Sweden University; Sweden
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Rondung E, Ternström E, Hildingsson I, Haines HM, Sundin Ö, Ekdahl J, Karlström A, Larsson B, Segeblad B, Baylis R, Rubertsson C. Comparing Internet-Based Cognitive Behavioral Therapy With Standard Care for Women With Fear of Birth: Randomized Controlled Trial. JMIR Ment Health 2018; 5:e10420. [PMID: 30097422 PMCID: PMC6109226 DOI: 10.2196/10420] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/21/2018] [Accepted: 06/06/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although many pregnant women report fear related to the approaching birth, no consensus exists on how fear of birth should be handled in clinical care. OBJECTIVE This randomized controlled trial aimed to compare the efficacy of a guided internet-based self-help program based on cognitive behavioral therapy (guided ICBT) with standard care on the levels of fear of birth in a sample of pregnant women reporting fear of birth. METHODS This nonblinded, multicenter randomized controlled trial with a parallel design was conducted at three study centers (hospitals) in Sweden. Recruitment commenced at the ultrasound screening examination during gestational weeks 17-20. The therapist-guided ICBT intervention was inspired by the Unified protocol for transdiagnostic treatment of emotional disorders and consisted of 8 treatment modules and 1 module for postpartum follow-up. The aim was to help participants observe and understand their fear of birth and find new ways of coping with difficult thoughts and emotions. Standard care was offered in the three different study regions. The primary outcome was self-assessed levels of fear of birth, measured using the Fear of Birth Scale. RESULTS We included 258 pregnant women reporting clinically significant levels of fear of birth (guided ICBT group, 127; standard care group, 131). Of the 127 women randomized to the guided ICBT group, 103 (81%) commenced treatment, 60 (47%) moved on to the second module, and only 13 (10%) finished ≥4 modules. The levels of fear of birth did not differ between the intervention groups postintervention. At 1-year postpartum follow-up, participants in the guided ICBT group exhibited significantly lower levels of fear of birth (U=3674.00, z=-1.97, P=.049, Cohen d=0.28, 95% CI -0.01 to 0.57). Using the linear mixed models analysis, an overall decrease in the levels of fear of birth over time was found (P≤ .001), along with a significant interaction between time and intervention, showing a larger reduction in fear of birth in the guided ICBT group over time (F1,192.538=4.96, P=.03). CONCLUSIONS Fear of birth decreased over time in both intervention groups; while the decrease was slightly larger in the guided ICBT group, the main effect of time alone, regardless of treatment allocation, was most evident. Poor treatment adherence to guided ICBT implies low feasibility and acceptance of this treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT02306434; https://clinicaltrials.gov/ct2/show/NCT02306434 (Archived by WebCite at http://www.webcitation.org/70sj83qat).
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Affiliation(s)
- Elisabet Rondung
- Department of Psycholgy, Mid Sweden University, Östersund, Sweden
| | - Elin Ternström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Helen M Haines
- Department of Rural Health, The University of Melbourne, Victoria, Australia
| | - Örjan Sundin
- Department of Psycholgy, Mid Sweden University, Östersund, Sweden
| | - Johanna Ekdahl
- Department of Psycholgy, Mid Sweden University, Östersund, Sweden
| | | | | | - Birgitta Segeblad
- Department of Obstetrics and Gynecology, Uppsala University Hospital, Uppsala, Sweden
| | - Rebecca Baylis
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Christine Rubertsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Health Science, Faculty of Medicine, Lund university, Lund, Sweden
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Arnon Z, Dor A, Bazak H, Attias S, Sagi S, Balachsan S, Schiff E. Complementary medicine for laboring women: a qualitative study of the effects of reflexology. ACTA ACUST UNITED AC 2018; 16:jcim-2018-0022. [DOI: 10.1515/jcim-2018-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/28/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Despite pharmacological interventions, labor pain and anxiety still remain a challenge, and can carry long-term psychological complications. The goal of this study was to assess the effect of reflexology on these symptoms and to explore the physical and psychological components of women’s experience associated with this treatment.
Methods
This qualitative study was conducted in an Israeli university hospital that offers integrative medicine services. Reflexology was offered to laboring women in the hospital, by the medical staff. In-depth, open interviews were conducted with 36 women, still in hospital, who consented to be interviewed, within 48 h after delivery. Questions referred to their labor experience with reflexology treatment.
Results
Of the 36 participants, 34 (94%) described a positive and empowering experience. They reported reduced pain and anxiety, and an increased sense of self-efficacy brought about by the ability to become active and manage labor.
Conclusions
Using reflexology as one of the complementary medicine treatment available can contribute greatly to the entire labor experience as it empowers women and increases self-confidence and ability to self-manage labor and delivery.
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Affiliation(s)
- Zahi Arnon
- Department of Behavioral Science , The Max Stern Yezreel Valley College , Yezreel Valley , Israel
- Integrative Medicine Service , Bnai Zion Medical Center , Haifa , Israel
| | - Asnat Dor
- Department of Behavioral Science , The Max Stern Yezreel Valley College , Yezreel Valley , Israel
- Department of Education , The Max Stern Yezreel Valley College , Yezreel Valley , Israel
| | - Hadar Bazak
- Outstanding Students’ Program – Department of Behavioral Science , The Max Stern Yezreel Valley College , Yezreel Valley , Israel
| | - Samuel Attias
- Integrative Medicine Service , Bnai Zion Medical Center , Haifa , Israel
- School of public Health , University of Haifa , Haifa , Israel
| | - Shlomi Sagi
- Department of Obstetrics and Gynecology , Bnai Zion Medical Center , Haifa , Israel
| | | | - Elad Schiff
- Integrative Medicine Service , Bnai Zion Medical Center , Haifa , Israel
- Faculty of Medicine , Technion – Israel Institute of Technology , Haifa , Israel
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Stoll K, Swift EM, Fairbrother N, Nethery E, Janssen P. A systematic review of nonpharmacological prenatal interventions for pregnancy-specific anxiety and fear of childbirth. Birth 2018; 45:7-18. [PMID: 29057487 DOI: 10.1111/birt.12316] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Despite a sharp increase in the number of publications that report on treatment options for pregnancy-specific anxiety and fear of childbirth (PSA/FoB), no systematic review of nonpharmacological prenatal interventions for PSA/FoB has been published. Our team addressed this gap, as an important first step in developing guidelines and recommendations for the treatment of women with PSA/FoB. METHODS Two databases (PubMed and Mendeley) were searched, using a combination of 42 search terms. After removing duplicates, two authors independently assessed 208 abstracts. Sixteen studies met eligibility criteria, ie, the article reported on an intervention, educational component, or treatment regime for PSA/FoB during pregnancy, and included a control group. Independent quality assessments resulted in the retention of seven studies. RESULTS Six of seven included studies were randomized controlled trials (RCTs) and one a quasi-experimental study. Five studies received moderate quality ratings and two strong ratings. Five of seven studies reported significant changes in PSA/FoB, as a result of the intervention. Short individual psychotherapeutic interventions (1.5-5 hours) delivered by midwives or obstetricians were effective for women with elevated childbirth fear. Interventions that were effective for pregnant women with a range of different fear/anxiety levels were childbirth education at the hospital (2 hours), prenatal Hatha yoga (8 weeks), and an 8-week prenatal education course (16 hours). CONCLUSIONS Findings from this review can inform the development of treatment approaches to support pregnant women with PSA/FoB.
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Affiliation(s)
- Kathrin Stoll
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - Emma Marie Swift
- Department of Nursing, University of Iceland, Reykjavík, Iceland
| | - Nichole Fairbrother
- Department of Psychiatry, University of British Columbia, Island Medical Program, Victoria, Canada
| | - Elizabeth Nethery
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - Patricia Janssen
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
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Bright KS, Norris JM, Letourneau NL, King Rosario M, Premji SS. Prenatal Maternal Anxiety in South Asia: A Rapid Best-Fit Framework Synthesis. Front Psychiatry 2018; 9:467. [PMID: 30364304 PMCID: PMC6193096 DOI: 10.3389/fpsyt.2018.00467] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/06/2018] [Indexed: 01/13/2023] Open
Abstract
Background: Most research efforts toward prenatal maternal anxiety has been situated in high-income countries. In contrast, research from low- and middle-income countries has focused on maternal depression and prenatal maternal anxiety in low- and middle-income countries remains poorly understood. Objectives: To examine whether dimensions and attributes of current maternal anxiety assessment tools appropriately capture South Asia women's experiences of perinatal distress during pregnancy. Design: We conducted a rapid review with best fit framework synthesis, as we wished to map study findings to an a priori framework of dimensions measured by prenatal maternal anxiety tools. Data Sources: We searched MEDLINE, PsycINFO, and CINAHL and gray literature in November 2016. Studies were included if published in English, used any study design, and focused on women's experiences of prenatal/antenatal anxiety in South Asia. Review Methods: Study quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool and Critical Appraisal Skills Programme Qualitative Checklist. Study findings were extracted to an a priori framework derived from pregnancy-related anxiety tools. Results: From 4,177 citations, 9 studies with 19,251 women were included. Study findings mapped to the a priori framework apart from body image. A new theme, gender inequality, emerged from the studies and was overtly examined through gender disparity, gender preference of fetus, or domestic violence. Conclusions: Gender inequality and societal acceptability of domestic violence in South Asian women contextualizes the experience of prenatal maternal anxiety. Pregnancy-related anxiety tools should include domains related to gender inequality to better understand their influence on pregnancy outcomes.
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Affiliation(s)
| | - Jill M Norris
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
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Kinser PA, Thacker LR, Lapato D, Wagner S, Roberson-Nay R, Jobe-Shields L, Amstadter A, York TP. Depressive Symptom Prevalence and Predictors in the First Half of Pregnancy. J Womens Health (Larchmt) 2017; 27:369-376. [PMID: 29240527 DOI: 10.1089/jwh.2017.6426] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Major depression during the peripartum (MDP) period carries significant public health impact due to the potential adverse effects on maternal, infant, and family outcomes. METHODS As part of a larger longitudinal study, this cross-sectional observational study sought to build upon the current literature on the prevalence and predictors of depression in the early second trimester of pregnancy, as related to generally accepted risk factors and other less explored risk factors. RESULTS The findings from this study suggest that in this sample of 230 black and white women at ∼14 weeks gestation, ∼19% endorsed depressive symptoms and that the most important predictors of depression in pregnancy were a preconception history of a mental health issue (e.g., lifetime depressive episode) and perceived stress. Other relevant predictors were pregnancy-related anxiety, income, and stressful life events. CONCLUSION/CLINICAL RELEVANCE It is important for clinicians not only to screen for MDP during prenatal visits by asking about current depressive, stress, and anxiety symptoms but also to identify patients at risk for MDP by asking simple questions about history of preconception/lifetime episodes of depression and stressful life events. Given the variance accounted for by lifetime depression, additional research into how clinicians may approach this important topic is warranted. For example, checklists given in the waiting room may be less likely to elicit endorsement compared with conversations aimed to normalize the range of depressive histories that may have relevance to obstetric health.
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Affiliation(s)
- Patricia Anne Kinser
- 1 Department of Family and Community Health Nursing, Virginia Commonwealth University School of Nursing , Richmond, Virginia
| | - Leroy R Thacker
- 1 Department of Family and Community Health Nursing, Virginia Commonwealth University School of Nursing , Richmond, Virginia.,2 Department of Biostatistics, Virginia Commonwealth University , Richmond Virginia
| | - Dana Lapato
- 3 Department of Human and Molecular Genetics, Virginia Commonwealth University , Richmond Virginia
| | - Sara Wagner
- 1 Department of Family and Community Health Nursing, Virginia Commonwealth University School of Nursing , Richmond, Virginia
| | - Roxann Roberson-Nay
- 4 Department of Psychiatry and Psychology, Virginia Commonwealth University , Richmond Virginia
| | - Lisa Jobe-Shields
- 5 Department of Psychology, University of Richmond , Richmond, Virginia
| | - Ananda Amstadter
- 4 Department of Psychiatry and Psychology, Virginia Commonwealth University , Richmond Virginia
| | - Timothy P York
- 3 Department of Human and Molecular Genetics, Virginia Commonwealth University , Richmond Virginia
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50
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Matthies LM, Wallwiener S, Müller M, Doster A, Plewniok K, Feller S, Sohn C, Wallwiener M, Reck C. Maternal self-confidence during the first four months postpartum and its association with anxiety and early infant regulatory problems. Infant Behav Dev 2017; 49:228-237. [PMID: 28987983 DOI: 10.1016/j.infbeh.2017.09.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 08/24/2017] [Accepted: 09/18/2017] [Indexed: 12/23/2022]
Abstract
Maternal self-confidence has become an essential concept in understanding early disturbances in the mother-child relationship. Recent research suggests that maternal self-confidence may be associated with maternal mental health and infant development. The current study investigated the dynamics of maternal self-confidence during the first four months postpartum and the predictive ability of maternal symptoms of depression, anxiety, and early regulatory problems in infants. Questionnaires assessing symptoms of depression (Edinburgh Postnatal Depression Scale), anxiety (State-Trait Anxiety Inventory), and early regulatory problems (Questionnaire for crying, sleeping and feeding) were completed in a sample of 130 women at three different time points (third trimester (T1), first week postpartum (T2), and 4 months postpartum (T3). Maternal self-confidence increased significantly over time. High maternal trait anxiety and early infant regulatory problems negatively contributed to the prediction of maternal self-confidence, explaining 31.8% of the variance (R=.583, F3,96=15.950, p<.001). Our results emphasize the transactional association between maternal self-confidence, regulatory problems in infants, and maternal mental distress. There is an urgent need for appropriate programs to reduce maternal anxiety and to promote maternal self-confidence in order to prevent early regulatory problems in infants.
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Affiliation(s)
- Lina Maria Matthies
- University of Heidelberg, Department of Obstetrics and Gynecology, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Stephanie Wallwiener
- University of Heidelberg, Department of Obstetrics and Gynecology, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany.
| | - Mitho Müller
- Ludwig Maximilian University, Department of Psychology, Leopoldstr. 13, 80802 Munich, Germany
| | - Anne Doster
- University of Heidelberg, Department of Obstetrics and Gynecology, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Katharina Plewniok
- University of Heidelberg, Department of Obstetrics and Gynecology, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Sandra Feller
- University of Heidelberg, Department of Obstetrics and Gynecology, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Christof Sohn
- University of Heidelberg, Department of Obstetrics and Gynecology, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Markus Wallwiener
- University of Heidelberg, Department of Obstetrics and Gynecology, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Corinna Reck
- Ludwig Maximilian University, Department of Psychology, Leopoldstr. 13, 80802 Munich, Germany
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