Association Between Antenatal and Postpartum Depression and Anxiety with Weight Retention 1 Year After Childbirth: A Longitudinal Study

The longitudinal trajectory of depression and anxiety across the perinatal period

The understanding of long-term depression and anxiety trajectories across the perinatal periods is lacking. This longitudinal study investigated the change trajectories of both depressive and anxiety symptoms, as well as the associations of their trajectories over five years. The study included nulliparous participants (N = 163, Mage = 33.47, SDage = 3.53) with self-reported depressive and anxiety symptoms collected via questionnaires at 30- and 35 weeks' gestation, 1.5, 3, 6, 12, 24, and 60 months postpartum. Data were analysed using structural equation latent growth modelling with and without covariates. Symptoms of depression increased significantly during pregnancy (p < .001), and both depression and anxiety symptoms increased during postpartum (p-values<.001). A previous mental health history was significantly associated with greater depressive symptomology (p = .001), and White individuals (compared to non-White) tended to have greater depression and anxiety symptoms during pregnancy (p-values<.05). At 30- and 35-weeks' gestation, 6 weeks postpartum, 3, 6, 12, 24 months, and 5 years postpartum 2.5 %, 2.0 %, 4.6 %, 4.0 %, 7.3 %, 5.6 %, 3.5 % and 8.0 % of participants had clinically significant depressive symptoms and 6.1 %, 8.5 %, 7.1 %, 12.0 %, 11.9 %, 8.1 %, 7.9 %, and 28 % had clinically significant anxiety symptoms. This study highlights the need to assess both depression and anxiety in perinatal care, and to identify individuals who may require intervention.

Effect of mode of delivery on postpartum weight retention: A systematic review and meta-analysis

OBJECTIVE

Retention of weight gained over pregnancy increases the risk of long-term obesity and related health concerns. While many risk factors for this postpartum weight retention have been examined, the role of mode of delivery in this relationship remains controversial. We carried out a systematic review and meta-analysis to determine the effect of mode of delivery on postpartum weight retention.

METHODS

Ten electronic databases including PubMed, Cochrane Library, EMBASE, Web of Science, MEDLINE, CINAHL, China National Knowledge Infrastructure (CNKI), Wan-Fang database, the VIP database and China Biology Medicine Database (CBM) were searched from inception through November 2022. Review Manager 5.4 was used to pool the study data and calculate effect sizes. For dichotomous data, the odds ratio and 95 % confidence interval were used to report the results. For continuous data, the mean difference (MD) and 95 % confidence interval were used to report the results. The outcomes were the amount of postpartum weight retention and the number or proportion of women who experienced postpartum weight retention. The Newcastle- Ottawa Scale (NOS) and GRADE Guidelines were used to assess the methodological quality of the included studies.

FINDINGS

A total of 16 articles were included in the systematic review and 13 articles were included in the meta-analysis. The results showed that the mode of delivery had a significant effect on postpartum weight retention, women who delivered by caesarean section were more likely to experience postpartum weight retention compared to those who delivered vaginally. Sensitivity analysis showed that the results were stable and credible.

CONCLUSION

Due to the limitations of this study, the findings need to be treated with caution. And, to better prevent the postpartum weight retention, future practice and research need to further focus on upstream modifiable factors.

Depression during pregnancy and gestational weight gain: A study of Brazilian pregnant women

OBJECTIVES

The relationship between psychosocial factors/mental health/depressive symptoms and inadequate gestational weight (GW) change remains poorly understood. Thus, the aim of this study was to evaluate the association between depressive symptoms and inadequate GW change according to the criteria established by the Institute of Medicine in 2009.

METHODS

This cross-sectional study was part of a prospective cohort, and conducted in Botucatu, São Paulo, Brazil. Pregnant women who received prenatal care at basic health care units in the city participated in the study (n = 297). The Edinburgh Postnatal Depression Scale was used to assess depressive symptoms during pregnancy, and the cutoff point used for the positive screening of depressive symptoms was ≥13. The association between depressive symptoms and two outcomes (insufficient and excessive weight change during second and third trimesters) was investigated using logistic regression models with adjustment for potential confounders. Crude and adjusted effect measures (odds ratios) and their relevant 95% confidence intervals were estimated.

RESULTS

There was an association between a positive score for depression during pregnancy and insufficient GW gain. No association was observed between depressive symptoms and excessive GW gain.

CONCLUSIONS

The presence of depressive symptoms significantly increased the chance of insufficient GW change. This finding enhances the need for screening for depression in prenatal care.

A Conceptual Analysis of Mental Health Maladaptation in Postpartum

Aim: This concept analysis aims to explore how the concept of maladaptation applies to mental health changes among postpartum women. Background: The concept of maladaptation is utilized throughout various disciplines but minimally in women's health, including a limited focus on maladaptive body dissatisfaction and perfectionistic beliefs of women in the postpartum period. Methods: The Walker and Avant eight-phase model was used to guide this analysis. Data Source: A search for maladaptation articles through Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, ProQuest, and PubMed databases, as well as Google Scholar, was conducted. Results: A review of the literature concerning maladaptation in postpartum mental health resulted in defining two key attributes, including conforming to cultural norms of body image and pressure of perfection. In understanding maladaptation and its attributes, childbirth educators and health-care professionals will be able to better determine more contributing factors for postpartum depression (PPD) and formulate a plan that includes early intervention and support. Conclusion: This concept analysis is intended to improve maternal and neonatal health outcomes by understanding mental health maladaptations related to PPD.

Primiparous Adaptation with Postpartum Health Issues in Jeddah City, Kingdom of Saudi Arabia: A Quantitative Study

Background: The postpartum or puerperium period is the first 6 weeks after giving birth to an infant. The postpartum period can have negative implications, especially in first-time mothers. With their transition into motherhood, new mothers adopt new lifestyles, which can affect their physical wellbeing. Childbirth has physical, psychological, and emotional effects on women as they try to adapt to their new roles in order to get through this period with no or minimal health issues. Study Aim: The current study aims to explore primiparous adaptations with postpartum health issues in Jeddah City at Kingdom of Saudi Arabia. Methods: The research design is quantitative cross-sectional. A structured questionnaire was developed to collect data in relation to depression and weight gain, which consider the most common postpartum health issues. The inclusion criteria of the participants are: primipara, 2 to 6 months postpartum, and living in Jeddah. Results: 140 participants were included in the study. Mothers gained approximately 9.2 kg within the fifth to ninth month after giving birth. Discussion: Postpartum weight retention is a primary challenge in the majority of primiparous mothers and results in reduced quality of life. Nurses were always available to answer questions related to the postpartum health issues and explained the expectations to the family members. Conclusions: Childbirth and the postpartum period for first-time mothers are crucial in their lives as they try to adapt to a new way of life. The postpartum period can have negative implications, especially in first-time mothers. With their transition into motherhood, new mothers adopt new lifestyles, which can affect their physical wellbeing. More research is needed to explore the impact of postpartum health issues in Saudi Arabia.

Edinburgh Postnatal Depression Scale used in South Korea

Background: The Edinburgh Postnatal Depression Scale (EPDS), a validated screening tool for prenatal and postnatal depression, was included as a reimbursable item by the National Health Insurance Service of Korea in 2020. However, multiple Korean versions of the EPDS are used for public health programs and research. This study aimed to summarize the use of this scale in Korea and evaluate the distribution of validities, depression scores, and prevalence of depression according to Korean versions of the EPDS.Methods: Korean versions of the EPDS most frequently used in public health policies and programs were summarized through internet searches using snowball strategy. A systematic literature review was conducted to evaluate the prenatal and postnatal depression scores and prevalence of depression measured using different Korean versions of the scale.Results: We identified four Korean versions of the EPDS that are commonly used in public health programs and research. Among them, published evidence regarding validity and reliability was available for two versions. A review of 19 papers that assessed prenatal and postnatal depression using these versions showed large heterogeneity in scores and the prevalence of depression.Conclusion: When measuring prenatal and postnatal depression using the EPDS, characteristics of the scale must be considered when interpreting results. A standardized Korean version of the EPDS needs to be developed by comparing the validity and reliability of different Korean versions. A field manual for screening should also be developed and distributed.

Differences in levels of stress, social support, health behaviours, and stress-reduction strategies for women pregnant before and during the COVID-19 pandemic, and based on phases of pandemic restrictions, in Ireland

BACKGROUND

The COVID-19 pandemic and related restrictions can adversely impact antenatal maternal well-being and health behaviours.

AIM

To examine antenatal stress and stress-reduction strategies, social support, and health behaviours between women pregnant before and during the pandemic in Ireland.

METHODS

210 pregnant women were recruited online and in the antenatal department of a tertiary maternity hospital before the pandemic, and 235 women recruited online during the pandemic. Only women resident in Ireland were included in this study. Women completed measures of stress, social support, health-behaviours, and self-reported stress-reduction strategies. Differences in outcomes were examined between women pregnant before and during the pandemic, and between Phase 2 and Phase 3 of the Irish Government COVID-19 restrictions.

FINDINGS

Women pregnant during the pandemic reported lower perceived social support, including support from a significant other, friends and family, than women pregnant before the pandemic. There were no significant differences in stress in health behaviours but women reported higher stress and less physical activity during the pandemic. Women reported a range of comparable stress-reduction strategies before and during the pandemic. No differences were observed between phases of pandemic-related restrictions for any outcome.

DISCUSSION

Our findings highlight negative impacts of the pandemic on social support, stress, and physical activity, which can have implications for maternal and child health. Lack of differences between restriction phases suggests on-going negative effects for antenatal well-being and behaviours.

CONCLUSION

Development of supports for pregnant women during the pandemic should include social-support and stress-reduction components.

Influence of prenatal perceived stress on postpartum weight retention is mediated by high gestational weight gain in women with overweight

Women with excessive gestational weight gain (GWG) are at risk for poor psychosocial well-being and postpartum weight retention (PPWR). Scant research has examined longitudinal interrelations of GWG, psychosocial factors, and PPWR. This study examined: (a) pre-pregnancy weight status (ie, normal, overweight, obesity) differences in PPWR and its psychosocial determinants (perceived social support, perceived stress, depression) in women with excessive GWG (ie, above 2009 Institute of Medicine guidelines); and (b) whether GWG mediated associations between psychosocial determinants and PPWR. Women (N = 1352) reported third trimester perceived social support, perceived stress, and depressive symptoms, GWG, and 6- and 12-month PPWR via telephone interviews. Multivariate ANOVA analyses showed women with normal weight had higher 6-month PPWR than women with obesity; univariate ANOVA showed no group differences in psychosocial factors. Hayes mediation analyses indicated that GWG mediated the association between perceived stress and PPWR in women with overweight but not women with normal weight or obesity; perceived stress predicted GWG, and in turn, PPWR. Prenatal perceived stress may be a modifiable target of GWG and PPWR. Future research is needed to examine the utility of tailoring perinatal weight regulation interventions to reduce perceived stress in pregnant women with overweight.

Mental health of adolescents associated with sexual and reproductive outcomes: a systematic review

Objective

To systematically review the literature on the mental health of adolescents associated with sexual and reproductive outcomes, and compare the mental health outcomes with that of other age groups.

Methods

We searched seven databases for relevant peer-reviewed articles published between 1 January 2010 and 25 April 2019. Our inclusion criteria required that the study included age-disaggregated data on adolescents, and focused and assessed mental health outcomes associated with pregnancy or sexually transmitted infections. We extracted data on the specific health event, the mental health outcome and the method of measuring this, and comparisons with other age groups.

Findings

After initially screening 10 818 articles by title and abstract, we included 96 articles in our review. We observed that a wide-ranging prevalence of mental ill-health has been reported for adolescents. However, most studies of mental health during pregnancy did not identify an increased risk of depression or other mental disorders among adolescents compared with other age groups. In contrast, the majority of studies conducted during the postpartum period identified an increased risk of depression in adolescents compared with other age groups. Three studies reported on mental health outcomes following abortion, with varying results. We found no studies of the effect of sexually transmitted infections on mental health among adolescents.

Conclusion

We recommend that sexual and reproductive health services should be accessible to adolescents to address their needs and help to prevent any adverse mental health outcomes.

Pre-natal and post-natal anxiety in relation to pre-pregnancy obesity: A cohort study on Iranian pregnant women

Background:

To determine the association between pre-conception obesity and screening results of pre-natal and post-natal anxiety in women that referred to the health centers of Tabriz, Iran.

Methods:

62 obese (class 2-3) and 245 normal-weight women were enrolled in the first trimester of pregnancy through the cohort study and followed-up 1 year after childbirth from December 2012 to January 2016. The Beck anxiety inventory scale (BAI-II) was completed in five time points: the first, second, third trimester of pregnancy, 6–8 weeks and 12 months after childbirth. Chi-square, Fisher’s exact tests, Independent t-test, Mann-Whitney, and multivariate logistic regression adjusted for confounders were used for data analysis. Statistically significant was considered as p<0.05.

Results:

The rate of moderate to severe anxiety in 1^st, 2^nd, 3^rd trimesters of gestation, 6–8 weeks and 12 months after birth was 8.6%, 10%, 12.6%, 7.8%, 6.5% in normal weight women versus 18%, 17.9%, 19.2%, 12.5%, 19.4% in obese class II women, respectively. The odds of anxiety in the first trimester of pregnancy for class 2–3 obesity was 2.72-fold greater than normal weight group [adjusted odds ratio (aOR) 2.72, 95% confidence interval (CI) 1.14–6.47; p=0.023]. This odd was 3.30- fold (aOR 3.30, 95%CI 1.13-9.60; p=0.045) for 1 year after birth.

Conclusion:

Obesity remained associated with positive screening for anxiety in the first trimester of pregnancy and one year after birth. Obese women more likely require special medical care during their pregnancy due to its impacts on mood.

Psychological distress profiles in expectant mothers: What is the association with pregnancy-related and relational variables?

INTRODUCTION

Research has progressively focused on antenatal psychological disease of expectant mothers, showing that anxiety and depression as well as fear of childbirth occur frequently during pregnancy. Some studies have investigated the connection between anxiety, depression, and fear of childbirth with contrasting results. Several authors have analyzed the association between psychological disease of pregnant women and numerous medical-obstetric and relational variables, still reporting inconclusive findings. The present study had three aims: 1) to investigate the psychological well-being of pregnant women based on their levels of anxiety, depression, and fear of childbirth, by identifying psychological profiles; (2) to analyze the association between the emergent psychological profiles and some medical-obstetric variables related to pregnancy; and (3) to examine the association between these profiles and couple's adjustment and social support.

METHODS

410 Italian primiparous pregnant women in the 7th-8th month of pregnancy completed a questionnaire packet on site that included the following scales: Wijma Delivery Expectancy Questionnaire, Edinburgh Postnatal Depression Scale, State-Trait Anxiety Inventory, Dyadic Adjustment Scale, Multidimensional Scale of Perceived Social Support.

RESULTS

Findings revealed the presence of three different clusters: "psychologically healthy women" (34.9%), comprised of women characterized by low levels of symptoms on all the scales; "women experiencing pregnancy- and childbirth-related anxiety" (47.3%), which groups women with an average state anxiety over the clinical value; and "psychologically distressed women" (17.8%), comprised of women who reported high levels of symptoms on all the scales, some above the clinical cut-offs. These profiles were not related to the medical-obstetric variables. On the other hand, findings revealed a significant association between marital adjustment as well as social support and cluster membership.

DISCUSSION

These results support the importance of early and multilevel psychological screening in order to understand the experience of pregnant women and to develop targeted and increasingly personalized interventions.