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Ryan N, Leahy-Warren P, Mulcahy H, O'Mahony S, Philpott L. The impact of perinatal maternal stress on the maternal and infant gut and human milk microbiomes: A scoping review protocol. PLoS One 2024; 19:e0304787. [PMID: 38837966 DOI: 10.1371/journal.pone.0304787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/17/2024] [Indexed: 06/07/2024] Open
Abstract
OBJECTIVE The objective of this scoping review is to review the research evidence regarding the impact of perinatal maternal stress on the maternal and infant gut and human milk microbiomes. INTRODUCTION Perinatal stress which refers to psychological stress experienced by individuals during pregnancy and the postpartum period is emerging as a public health concern. Early exposure of infants to perinatal maternal stress can potentially lead to metabolic, immune, and neurobehavioral disorders that extend into adulthood. The role of the gut and human milk microbiome in the microbiome-gut-brain axis as a mechanism of stress transfer has been previously reported. A transfer of colonised aberrant microbiota from mother to infant is proposed to predispose the infant to a pro- inflammatory microbiome with dysregulated metabolic process thereby initiating early risk of chronic diseases. The interplay of perinatal maternal stress and its relationship to the maternal and infant gut and human milk microbiome requires further systematic examination in the literature. INCLUSION CRITERIA This scoping review is an exploratory mapping review which will focus on the population of mothers and infants with the exploration of the key concepts of maternal stress and its impact on the maternal and infant gut and human milk microbiome in the context of the perinatal period. It will focus on the pregnancy and the post-natal period up to 6 months with infants who are exclusively breastfed. METHODS This study will be guided by the Joanna Briggs Institute's (JBI) methodology for scoping reviews along with use of the Prisma Scr reporting guideline. A comprehensive search will be conducted using the following databases, CINAHL Complete; MEDLINE; PsycINFO, Web of Science and Scopus. A search strategy with pre-defined inclusion and exclusion criteria will be used to retrieve peer reviewed data published in English from 2014 to present. Screening will involve a three-step process with screening tool checklists. Results will be presented in tabular and narrative summaries, covering thematic concepts and their relationships. This protocol is registered with Open Science Framework DOI 10.17605/OSF.IO/5SRMV.
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Affiliation(s)
- Niamh Ryan
- School of Nursing and Midwifery, University College Cork, Wilton, Cork, Ireland
| | | | - Helen Mulcahy
- School of Nursing and Midwifery, University College Cork, Wilton, Cork, Ireland
| | - Siobhain O'Mahony
- Department of Anatomy and Neuroscience, APC Microbiome Ireland, University College Cork, Ireland
| | - Lloyd Philpott
- School of Nursing and Midwifery, University College Cork, Wilton, Cork, Ireland
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Graziottin A, Di Simone N, Guarano A. Postpartum care: Clinical considerations for improving genital and sexual health. Eur J Obstet Gynecol Reprod Biol 2024; 296:250-257. [PMID: 38484617 DOI: 10.1016/j.ejogrb.2024.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/15/2024] [Accepted: 02/20/2024] [Indexed: 04/19/2024]
Abstract
The postpartum period encompasses the biological and psychoaffective transition to motherhood. However, it remains a most neglected phase in a woman's life. Furthermore, the transition to parenthood is a critical and potentially disrupting factor in a couple's relationship, which can be complicated by undiagnosed biological and psychosexual difficulties. Lack of recognition of the many biological and medical factors that can affect women's health and sexuality in the postpartum period is a common and persistent clinical omission worldwide. Communication difficulties exist between healthcare professionals and women and there are wording biases in describing female genitalia. This can further contribute to the diagnostic lack of attention and timely diagnosis and treatment of even very bothersome symptoms. Early diagnosis and treatment of common postpartum conditions is vital and quality care for new mothers should include psychological and emotional support, lactation assistance, early diagnosis and treatment of genital and sexual pain symptoms, pelvic floor rehabilitation and sexual health guidance. The inclusion of correct genital hygiene practices is a critical element of postpartum gynaecological counselling and can help improve overall genital and sexual health. In this review, we summarise the variability in global professional guidelines for postpartum care, identify common health problems faced by postpartum women and discuss appropriate postpartum care. We pay specific attention to prominent biological or medical factors that can impact the emotional and psychosexual wellbeing of women and couples. The aetiology, diagnosis and treatment of sexual dysfunction, in particular sexual pain disorders, is therefore discussed with a pragmatic approach. Finally, the role of intimate hygiene care is discussed with special attention given to cleanser ingredients with solid scientific evidence to help clinicians adopt a more tailored approach with their clinical recommendations.
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Affiliation(s)
- Alessandra Graziottin
- Centre of Gynaecology and Medical Sexology, Department of Obstetrics and Gynaecology, San Raffaele Resnati Hospital, 20122 Milan, Italy; Department of Obstetrics and Gynaecology, University of Verona, 37129 Verona, Italy; Specialty School, Endocrinology and Metabolic Diseases Department, Federico II University, 80131 Naples, Italy; Alessandra Graziottin Foundation for the Cure and Care of Pain in Women, NPO, Italy
| | - Nicoletta Di Simone
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy; IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Alice Guarano
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy.
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Gennaro S, Melnyk BM, Szalacha LA, Hoying J, Cooper A, Aviles MM, O'Connor C, Gibeau A. Depression, anxiety, and stress in pregnant Black people: A case for screening and evidence-based intervention. Nurse Pract 2023; 48:37-46. [PMID: 37991519 DOI: 10.1097/01.npr.0000000000000117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND Guidelines call for pregnant people to be screened for depression and anxiety. Screening may be particularly important for pregnant Black individuals who are reported to be more likely than non-Hispanic White pregnant people to experience prenatal stress, anxiety, and depressive symptoms. The purpose of this study was to determine if depression, anxiety, and stress co-occur in pregnant Black people and to identify which demographic factors are related to these mental health concerns. METHODS A subset analysis of an ongoing randomized controlled trial examined the risk of coexisting mental health conditions in pregnant Black people who screened eligible to participate (that is, they had high levels of depression, anxiety, and/or stress) in two urban clinics using a descriptive correlational design. RESULTS Of the 452 pregnant Black people who were screened for eligibility, 194 (42.9%) had elevated scores on depression, anxiety, and/or stress measures and were enrolled in the larger study. The average scores of the 194 enrolled participants were anxiety, mean (M) = 9.16 (standard deviation [SD] = 4.30); depression, M = 12.80 (SD = 4.27); and stress, M = 21.79 (SD = 4.76). More than one-third (n = 70, 36.1%) experienced two symptoms and 64 (33.0%) reported all three symptoms. CONCLUSION Pregnant Black individuals experience high levels of comorbid mental health distress including depression, anxiety, and stress. The findings indicate that treatment for mental health concerns needs to be broad-based and effective for all three conditions. Prenatal interventions should aim to address mental health distress through screening and treatment of depression, anxiety, and stress, especially for pregnant Black individuals. This study furthers understanding of the prevalence of prenatal mental health conditions in pregnant Black people.
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Wang Y, Gu J, Gao Y, Lu Y, Zhang F, Xu X. Postpartum stress in the first 6 months after delivery: a longitudinal study in Nantong, China. BMJ Open 2023; 13:e073796. [PMID: 37865410 PMCID: PMC10603468 DOI: 10.1136/bmjopen-2023-073796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 09/05/2023] [Indexed: 10/23/2023] Open
Abstract
OBJECTIVES The objective is to to explore the longitudinal change trajectories of postpartum stress and its related factors. DESIGN A longitudinal study with follow-ups from 42 days to 6 months after delivery. SETTINGS AND PARTICIPANTS A total of 406 postpartum women were recruited at baseline (42 days after delivery) from 6 hospitals in Nantong, Jiangsu Province, China, and followed up at 3 and 6 months. After the follow-ups, 358 postpartum women were retained for further analysis. METHODS Postpartum stress was evaluated using the Maternal Postpartum Stress Scale (MPSS) at baseline (42 days) and 3 and 6 months after delivery. MPSS has three dimensions, such as: personal needs and fatigue, infant nurturing and body changes and sexuality. Postpartum depression and anxiety were measured using the Edinburgh Postnatal Depression Scale and the short-form Depression, Anxiety and Stress Scale, respectively. The MPSS scores were normalised using a rank-based inverse normal transformation. RESULTS Postpartum stress decreased significantly after 3 months, and postpartum stress reduced further after 6 months. Additionally, the scores for all three dimensions reduced after 6 months, while infant nurturing reduced after both 3 and 6 months. Older age (β=0.028, p=0.049), higher education level (β=0.153, p=0.005) and higher body mass index (BMI) (β=0.027, p=0.008) of the postpartum women were significantly associated with higher postpartum stress levels in corresponding dimensions at 42 days. Older age was also associated with higher postpartum stress at 3 (β=0.030, p=0.033) and 6 months (β=0.050, p<0.001) in the dimension of personal needs and fatigue. Postpartum stress levels were significantly higher in women with depression or anxiety symptoms. CONCLUSIONS Postpartum stress continuously declined from 42 days to 6 months after delivery. Postpartum women with older age, higher education levels, higher BMI and anxiety or depression symptoms should be the target population for early intervention.
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Affiliation(s)
- Yanchi Wang
- Affiliated Nantong Hospital of Shanghai University (The Sixth People's Hospital of Nantong), Nantong, Jiangsu, China
- Medical School of Nantong University, Nantong, Jiangsu, China
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Jian Gu
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Yuehong Gao
- The Fourth People's Hospital of Nantong, Nantong, Jiangsu, China
| | - Yi Lu
- Medical School of Nantong University, Nantong, Jiangsu, China
| | - Feng Zhang
- Medical School of Nantong University, Nantong, Jiangsu, China
| | - Xujuan Xu
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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Hannon S, Gartland D, Higgins A, Brown SJ, Carroll M, Begley C, Daly D. Physical health and comorbid anxiety and depression across the first year postpartum in Ireland (MAMMI study): A longitudinal population-based study. J Affect Disord 2023; 328:228-237. [PMID: 36801420 DOI: 10.1016/j.jad.2023.02.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 02/21/2023]
Abstract
INTRODUCTION Little is known of the associations between physical health issues and mental health issues such as anxiety, depression and comorbid anxiety and depression (CAD) occurring in the perinatal period. METHODS A longitudinal cohort study with 3009 first-time mothers giving birth in Ireland collected physical and mental health data in pregnancy and at 3, 6, 9 and 12 months postpartum. Mental health was measured using the depression and anxiety subscales of the Depression, Anxiety and Stress Scale. Experience of eight common physical health issues (e.g. severe headaches/migraines, back pain) were assessed in pregnancy, with an additional six assessed at each postpartum data collection point. RESULTS 2.4 % of women reported depression alone in pregnancy and 4 % reported depression across the first postpartum year. Anxiety alone was reported by 3.0 % of women in pregnancy, and 2 % in the first year postpartum. Prevalence of comorbid anxiety/depression (CAD) was 1.5 % in pregnancy and almost 2 % postpartum. A higher proportion of women reporting, compared to women not reporting, postpartum CAD were younger, not partnered, not in paid employment in pregnancy, have fewer years of education, and had a caesarean birth. Extreme tiredness/exhaustion and back pain were the most common physical health issues in pregnancy and postpartum. Constipation, haemorrhoids, bowel issues, breast issues, infection and pain in the perineum or caesarean wound, pelvic pain and urinary tract infections were highest at three months postpartum and gradually decreased thereafter. Women reporting depression alone or anxiety alone were equivalent in terms of physical health issues. However, women without mental health symptoms reported significantly fewer physical health issues than women reporting depressive or anxiety symptoms alone or CAD at every time point. Women with CAD reported a significantly higher number of health issues than women reporting depression alone or anxiety alone at 9 and 12 months postpartum. CONCLUSION Reports of mental health symptoms are associated with higher physical health burden demonstrating a need for integrated approaches in mental and physical health care pathways in perinatal services.
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Affiliation(s)
- Susan Hannon
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin DO2 T283, Ireland; Trinity Centre for Maternity Care Research (TCMCR), School of Nursing and Midwifery, Trinity College Dublin, No. 2 Clare Street, Dublin 2, Ireland.
| | - Deirdre Gartland
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Vic, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia.
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin DO2 T283, Ireland; Trinity Centre for Maternity Care Research (TCMCR), School of Nursing and Midwifery, Trinity College Dublin, No. 2 Clare Street, Dublin 2, Ireland.
| | - Stephanie J Brown
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Vic, Australia; Department of General Practice, University of Melbourne, Melbourne, Vic, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia.
| | - Margaret Carroll
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin DO2 T283, Ireland; Trinity Centre for Maternity Care Research (TCMCR), School of Nursing and Midwifery, Trinity College Dublin, No. 2 Clare Street, Dublin 2, Ireland.
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin DO2 T283, Ireland; Trinity Centre for Maternity Care Research (TCMCR), School of Nursing and Midwifery, Trinity College Dublin, No. 2 Clare Street, Dublin 2, Ireland.
| | - Déirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin DO2 T283, Ireland; Trinity Centre for Maternity Care Research (TCMCR), School of Nursing and Midwifery, Trinity College Dublin, No. 2 Clare Street, Dublin 2, Ireland.
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Trajectories of Postpartum Recovery: What is Known and Not Known. Clin Obstet Gynecol 2022; 65:594-610. [PMID: 35797600 DOI: 10.1097/grf.0000000000000726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Women's postpartum health is a public health issue that has lifelong consequences. Timely recognition and treatment of physical and mental health issues can have positive health consequences while lack of access to effective treatments or health care services can lead to long-term health problems. To advance knowledge of priority health symptoms and trajectories of postpartum recovery from women's health perspectives, we share findings from the Maternal health And Maternal Morbidity in Ireland (MAMMI) study. Data from 3047 first-time mothers recruited to a longitudinal maternal health study in Ireland from 2012 to 2017 reveal the trajectories of maternal health and health problems experienced up to 12 months postpartum. Morbidities explored include urinary incontinence, pelvic girdle pain, and sexual and mental health issues. Viewed together, and over time, the scale and persistent nature of many physical and mental health problems become apparent, yet considerable proportions of women were not asked directly about health problems by health care professionals. When women do not know what is and is not normal postpartum, they may suffer in silence and the consequence is that health problems/issues that are preventable, and treatable, are likely to become chronic. To make positive contributions to women's health, maternity care systems must be truly woman-centered and structured in ways that place emphasis on women's own health needs. In systems where women's voices and concerns are acknowledged and central, women are likely to thrive and flourish in motherhood.
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