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Kanamori Y, Miyamoto Y, Sawada U, Iida M, Tabuchi T, Nishi D. Association between adverse childhood experience and unintended pregnancy among Japanese women: a large-scale cross-sectional study. J Psychosom Obstet Gynaecol 2023; 44:2274295. [PMID: 37882689 DOI: 10.1080/0167482x.2023.2274295] [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: 08/23/2023] [Accepted: 10/18/2023] [Indexed: 10/27/2023] Open
Abstract
Unintended pregnancy (UP) can negatively impact the health of mothers, children, and families. While Adverse Childhood Experiences (ACEs) are increasingly known to affect sexual health, the influence on pregnancy intention is not fully understood. This study examines the relationship between ACEs and UP and explores other related factors, using 5049 pregnant and postpartum women data from the Japan COVID-19 and Society Internet Survey (JACSIS). We measured participants' pregnancy intentions, ACEs, family functioning, and social network size. Logistic regression analysis provided odds ratios and 95% confidence intervals (CI). The prevalence of UP was approximately 16.5% (n = 893). Cumulative ACEs were consistently associated with UP, even after adjusting for intermediate variables in adulthood. The odds ratio for UP with a single ACE was 1.00 (CI: 0.82-1.21) but rose significantly with multiple ACEs: 1.39 (CI: 1.10-1.76) with double, 1.38 (CI: 1.02-2.86) with triple, and 1.81 (CI: 1.37-2.39) with more. Additionally, bad family functioning and lack of social networks emerged as contributors to UP. In conclusion, this study showed that ACEs are potentially correlated with UP. A deeper understanding of the transition from childhood experiences to UP is important for health interventions, necessitating further investigation.
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Affiliation(s)
- Yoshiaki Kanamori
- Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Yuki Miyamoto
- Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Utako Sawada
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Mako Iida
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
- Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
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Beumer WY, Roseboom TJ, Koot MH, Vrijkotte T, van Ditzhuijzen J. Carrying an unintended pregnancy to term and long-term maternal psychological distress: Findings from the Dutch prospective Amsterdam Born Children and their Development study. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231213737. [PMID: 38062674 PMCID: PMC10704944 DOI: 10.1177/17455057231213737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Given the estimated high rate of unintended pregnancies, it is important to investigate long-term effects on psychological distress in women carrying an unintended pregnancy to term. However, research into associations between unintended pregnancies carried to term and psychological distress postpartum is mixed, and especially, evidence on long-term associations is scarce. OBJECTIVE To examine whether carrying an unintended pregnancy to term is associated with maternal psychological distress later in life, up to 12 years postpartum. DESIGN This study is based on the population-based birth cohort study 'Amsterdam Born Children and their Development' study, which included pregnant people in 2003 (n = 7784) and followed them up until 12 years postpartum. METHODS Unintended pregnancy was measured as a multidimensional construct, based on self-reported data around 16 weeks gestation on pregnancy mistiming, unwantedness and unhappiness. Symptoms of maternal psychological distress were assessed around 3 months, 5 years and 12 years postpartum using multiple questionnaires measuring symptoms of depression, anxiety and stress. Multiple structural equation modelling models were analysed, examining the associations between dimensions of unintended pregnancy and maternal psychological distress per time point, while controlling for important co-occurring risks. RESULTS Pregnancy mistiming and unhappiness were significant predictors of more maternal psychological distress around 3 months postpartum. Around 5 years postpartum, only pregnancy mistiming was positively associated with maternal psychological distress. Dimensions of unintended pregnancy were no longer associated with maternal psychological distress around 12 years postpartum. Strikingly, antenatal psychological distress was a much stronger predictor of maternal psychological distress than pregnancy intention dimensions. CONCLUSION Those who carried a more unintended pregnancy to term reported more symptoms of psychological distress at 3 months and 5 years postpartum. People carrying an unintended pregnancy to term may benefit from extra support, not because of the pregnancy intentions per se, but because they may be related to antenatal psychological distress.
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Affiliation(s)
- Wieke Y Beumer
- Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gynaecology, Amsterdam, Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
| | - Tessa J Roseboom
- Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gynaecology, Amsterdam, Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
| | - Marjette H Koot
- Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gynaecology, Amsterdam, Netherlands
| | - Tanja Vrijkotte
- Amsterdam UMC location Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam, Netherlands
| | - Jenneke van Ditzhuijzen
- Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gynaecology, Amsterdam, Netherlands
- Social Policy and Public Health, Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
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Muskens L, Boekhorst MGBM, Kop WJ, van den Heuvel MI, Pop VJM, Beerthuizen A. The association of unplanned pregnancy with perinatal depression: a longitudinal cohort study. Arch Womens Ment Health 2022; 25:611-620. [PMID: 35347473 PMCID: PMC9072423 DOI: 10.1007/s00737-022-01225-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/18/2022] [Indexed: 12/25/2022]
Abstract
Perinatal depression is common, affecting approximately 7-13% of women. Studies have shown an association between unplanned pregnancy and perinatal depressive symptoms, but many used a cross-sectional design and limited postnatal follow-up. The current study investigated the association of unplanned pregnancy with perinatal depressive symptoms using a longitudinal cohort study that followed women from the first trimester until 12 months postpartum. Pregnant women (N = 1928) provided demographic and clinical data and information about pregnancy intention at the first trimester. Depressive symptoms were assessed during each trimester of pregnancy and five times postpartum using the Edinburgh Postnatal Depression Scale (EPDS) until 12 months postpartum. Mixed model analyses were used to investigate the association between an unplanned pregnancy and the level of depressive symptoms. Women with an unplanned pregnancy (N = 111, 5.8%) reported persistently higher levels of depressive symptoms during the entire perinatal period compared to women with a planned pregnancy, after adjustment for confounders (p < 0.001). However, the course of depressive symptom scores over time in women with an unplanned pregnancy was similar to that of women with a planned pregnancy. Lower age (p = 0.006), unemployment (p = 0.004), and history of depression (p < 0.001) were significantly associated with higher levels of perinatal depressive symptoms. An unplanned pregnancy may have a long-lasting negative impact on a woman's perinatal mental health. Therefore, women with an unplanned pregnancy may benefit from systematic follow-up during the perinatal period with contingent mental health support.
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Affiliation(s)
- Lotte Muskens
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, Netherlands.
| | - Myrthe G. B. M. Boekhorst
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB Tilburg, Netherlands
| | - Willem J. Kop
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB Tilburg, Netherlands
| | | | - Victor J. M. Pop
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB Tilburg, Netherlands
| | - Annemerle Beerthuizen
- Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, Netherlands
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Wu F, Lin W, Liu P, Zhang M, Huang S, Chen C, Li Q, Huang W, Zhong C, Wang Y, Chen Q. Prevalence and contributory factors of anxiety and depression among pregnant women in the post-pandemic era of COVID-19 in Shenzhen, China. J Affect Disord 2021; 291:243-251. [PMID: 34051531 PMCID: PMC9754805 DOI: 10.1016/j.jad.2021.05.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pregnant women are emotionally vulnerable and have suffered great psychological impacts. Following the coronavirus disease 2019 (COVID-19) outbreak, a study was undertaken of the prevalence of, and factors contributing to, symptoms of anxiety and depression among pregnant women in Shenzhen, China. METHODS A cross-sectional study on pregnant women was conducted from September to December 2020 in Shenzhen, using a random-recruit method. The General Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) surveys were used to evaluate symptoms of anxiety and depression. A multivariate logistic regression model was developed to explore factors potentially associated with symptoms of anxiety and depression during pregnancy. RESULTS A total of 3,434 pregnant women aged 15 to 59 years were enrolled. Symptoms of anxiety and depression were present in 9.8% and 6.9%, respectively. Logistic regression analysis using a stepwise procedure revealed that an increased risk of symptoms of anxiety and depression was associated with unmarried/divorced/widowed, unemployed, received professional psychological counseling, family dysfunction, the first trimester of pregnancy, pregnancy complications and vaginal bleeding, unplanned pregnancy, decline in household income and disputes between partners caused by the COVID-19 pandemic, consumption of alcoholic drinks by women and their partners, smoking, lack of exercise and sedentary lifestyle. Women with education from junior high school through college were less likely to experience symptoms of prenatal depression. CONCLUSIONS Our study revealed factors associated with psychological symptoms among pregnant women in the post-COVID-19-pandemic era. These results should help to update guidance for psychological interventions for pregnant women during the period of COVID-19.
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Affiliation(s)
- Fei Wu
- Department of Epidemiology, School of Public Health, Guangdong Provincial Key Laboratory of Tropical Disease Research, Southern Medical University, Guangzhou 510515, Guangdong, China,Department of Healthcare, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518048, Guangdong, China
| | - Wei Lin
- Department of Healthcare, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518048, Guangdong, China
| | - Peiyi Liu
- Department of Healthcare, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518048, Guangdong, China
| | - Minyi Zhang
- Department of Epidemiology, School of Public Health, Guangdong Provincial Key Laboratory of Tropical Disease Research, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Shengbin Huang
- School of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Caiyun Chen
- Department of Epidemiology, School of Public Health, Guangdong Provincial Key Laboratory of Tropical Disease Research, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Qiushuang Li
- Department of Epidemiology, School of Public Health, Guangdong Provincial Key Laboratory of Tropical Disease Research, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Weikang Huang
- Department of Healthcare, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518048, Guangdong, China
| | - Chuyan Zhong
- Department of Healthcare, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518048, Guangdong, China
| | - Yueyun Wang
- Department of Healthcare, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518048, Guangdong, China.
| | - Qing Chen
- Department of Epidemiology, School of Public Health, Guangdong Provincial Key Laboratory of Tropical Disease Research, Southern Medical University, Guangzhou 510515, Guangdong, China.
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Unintended pregnancy and postpartum depression: A meta-analysis of cohort and case-control studies. J Psychosom Res 2020; 138:110259. [PMID: 33002811 DOI: 10.1016/j.jpsychores.2020.110259] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The majority of original studies showed that unintended pregnancy is related to adverse obstetric outcomes, however, up to now, the influence of unintended pregnancy on the risk of developing postpartum depression (PPD) remains unclear. This study aimed to assess the association between unintended pregnancy and the risk of developing PPD by conducting a meta-analysis of cohort and case-control studies. METHODS PubMed, Web of Science, Embase, and Cochrane Library were searched up to December 31, 2019 to identify relevant studies evaluating the association between unintended pregnancy and PPD. Meta-analysis was performed using RevMan software and Stata software. Potential heterogeneity source was explored by subgroup and sensitivity analyses, and potential publication bias was tested using Begg's funnel plots and Begg's linear regression test. RESULTS A total of thirty studies involving 65,454 participants were included in our meta-analysis. Overall, women who get pregnant unintendedly compared with those who are intending to be pregnant were at a significantly higher risk of developing PPD (odds ratio [OR] = 1.53; 95% confidence interval [CI]: 1.35-1.74; P < 0.00001). CONCLUSIONS Unintended pregnancy is significantly associated with the risk of developing PPD. These findings highlight the necessity of screening for pregnancy intention and integrating family planning and personalized mental health services into primary healthcare to promote maternal mental health.
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Abstract
PURPOSE OF REVIEW Women should enter pregnancy in the best possible health. There is increasing recognition of the importance of nutrition for reproductive health; however, key dietary factors in relation to optimizing fertility are nonexistent. The purpose of this review is to investigate dietary factors, preconception, and the association with fertility and later health in pregnancy. RECENT FINDINGS This article summarizes recent literature assessing preconception dietary intake and the association with fertility, time to pregnancy, and also the relationship with polycystic ovary syndrome and gestational diabetes; these conditions associate with each other, and also with infertility. The impact of paternal diet is also reported. SUMMARY There is recent interest investigating diet and time to pregnancy, suggesting higher intakes of fruit, minimal intake of fast food and sugar sweetened beverages, and a diet lower in glycemic load, may improve time to pregnancy. There is minimal recent literature on paternal diet and impact on fertility. Present advice to women with polycystic ovary syndrome is in line with international recommendations for lifestyle management to improve reproductive outcomes; and for gestational diabetes, prepregnancy may be an optimal time to improve dietary intakes, particularly through consumption of an overall healthy dietary pattern or a Mediterranean-style dietary pattern.
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Bales M, Pambrun E, Melchior M, Glangeaud-Freudenthal NC, Charles MA, Verdoux H, Sutter-Dallay AL. Prenatal Psychological Distress and Access to Mental Health Care in the ELFE Cohort. Eur Psychiatry 2020; 30:322-8. [DOI: 10.1016/j.eurpsy.2014.11.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/08/2014] [Accepted: 11/17/2014] [Indexed: 11/28/2022] Open
Abstract
AbstractBackground:Pregnant women are vulnerable to the deleterious impact of environmental stressors. The aims were to identify the environmental and pregnancy characteristics independently associated with prenatal psychological distress and access to mental health care.Methods:We used data from the French cohort Étude Longitudinale Française depuis l’Enfance (ELFE), a nationally representative cohort of children followed-up from birth to adulthood. Information about prenatal psychological status and access to mental health care was collected during the maternity stay. Maternal/pregnancy characteristics independently associated with psychological distress and access to mental health care were explored using multivariate analyses.Results:Of the 15,143 mothers included, 12.6% reported prenatal psychological distress. Prenatal distress was more frequent in women with very low economical status, alcohol/tobacco use, unplanned/unwanted pregnancy, late pregnancy declaration, multiparity and complicated pregnancy (high number of prenatal visits, prenatal diagnosis examination, obstetrical complications). Of the women reporting prenatal distress, 25% had a prenatal consultation with a mental health specialist and 11% used psychotropic drugs during pregnancy. Decreased likelihood to consult a mental health specialist was found in young women, with intermediate educational level and born abroad.Limitations:Causal inferences should be made cautiously as the questionnaire did not collect information on the temporal sequence between psychological distress and associated characteristics.Conclusions:Women with social and obstetrical vulnerabilities are at increased risk of poor mental health during pregnancy. Improving mental health care access during pregnancy is a public health priority.
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Association between unintended pregnancy and internalizing disorders among Latina and Asian American mothers. J Affect Disord 2019; 258:117-124. [PMID: 31401539 DOI: 10.1016/j.jad.2019.07.068] [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: 05/20/2019] [Revised: 07/28/2019] [Accepted: 07/29/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Pregnancy, whether intended or unintended, is associated with internalizing symptoms among women; for some, these symptoms cause impairment and develop into an internalizing disorder (ID). With the growing diversity of the US population, there is a need to understand how pregnancy relates to IDs among minorities. This study examines the association between unintended pregnancy and lifetime and 12-month history of IDs among Latina and Asian mothers. METHODS Data come from the National Latino and Asian American Study (NLAAS), a nationally representative sample of Latino and Asian adults. Pregnancy intention was self-reported. ID history was assessed with the CIDI (DSM-IV). Logistic regression was used to examine the association between pregnancy intention and likelihood of lifetime and 12-month IDs. RESULTS Among 1915 mothers, 24.1% and 14.7% met criteria for a lifetime and 12-month ID, respectively. Relative to those who only reported intended pregnancies, Asian mothers reporting an unintended pregnancy had the highest odds of lifetime (Odds ratio (OR): 2.51, 95% Confidence Interval (CI): 1.55-4.08) and 12-month IDs (OR: 5.73, 95% CI: 2.67-12.29). Latina mothers reporting unintended pregnancies also had higher odds of lifetime (OR: 1.96, 95% CI: 1.41-2.72) and 12-month IDs (OR: 1.70, 95% CI: 1.12-2.59). Socioeconomic status had no significant modifying effect. LIMITATIONS Cross-sectional data and retrospective recall and social desirability could misclassify pregnancy intention. CONCLUSIONS Unintended pregnancy is associated with higher odds of IDs among mothers. Findings underscore the complex relationship between unintended pregnancy and maternal mental health.
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Upadhyay AK, Singh A, Singh A. Association between unintended births and risk of postpartum depression: Evidence from Ethiopia, India, Peru and Vietnam. SSM Popul Health 2019; 9:100495. [PMID: 31650000 PMCID: PMC6804781 DOI: 10.1016/j.ssmph.2019.100495] [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: 05/07/2019] [Revised: 09/05/2019] [Accepted: 10/03/2019] [Indexed: 12/29/2022] Open
Abstract
Previous studies have shown that unintended births adversely affect birth outcomes, child health and cognitive development in developing countries. However, only a few studies have examined the association between unintended births and risk of postpartum depression (PPD) in these countries. The study uses data from the first wave of Young Lives Study (YLS) conducted in 2002 in Ethiopia, India, Peru and Vietnam to examine the association between birth intention and the risk of PPD. Bivariate and multivariable logistic regressions are used to examine the association. Bivariate result indicates that the risk of PPD was substantially higher among mothers who reported an unintended birth as compared to mothers who reported an intended birth in each country. Results from multivariable logistic regression models indicate that unintended births were associated with higher risk of PPD in pooled data (odds ratio: 1.46, 95%CI. 1.29, 1.66), Ethiopia (odds ratio: 1.99, 95% CI. 1.58,2.50), and Peru (odds ratio: 1.29, 95% CI. 1.04, 1.59) compared with mothers having an intended birth. Results suggest that reducing unintended births might help in reducing the incidence of PPD among mothers in these countries. One of the most cost-effective interventions for reducing the incidence of unintended births is the availability of effective family planning programme.
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Affiliation(s)
| | - Abhishek Singh
- International Institute for Population Sciences, Mumbai, India
| | - Ashish Singh
- SJM School of Management, Indian Institute of Technology Bombay, India
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Jacob L, Gerhard C, Kostev K, Kalder M. Association between induced abortion, spontaneous abortion, and infertility respectively and the risk of psychiatric disorders in 57,770 women followed in gynecological practices in Germany. J Affect Disord 2019; 251:107-113. [PMID: 30921593 DOI: 10.1016/j.jad.2019.03.060] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/06/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
Abstract
AIM Our goal was to analyze the association between induced abortion, spontaneous abortion, and infertility respectively and the risk of psychiatric disorders in 57,770 women followed in gynecological practices in Germany. METHODS This case-control study was based on data from the Disease Analyzer database (IQVIA). Women with a first documentation of depression, anxiety, adjustment disorder, or somatoform disorder in one of 281 gynecological practices in Germany between January 2013 and December 2017 were included in this study (index date). Controls without depression, anxiety, adjustment disorder, or somatoform disorder were matched (1:1) to cases by age, index year, and physician. A total of 57,770 women were included in the present study. The main outcome of the study was the risk of psychiatric disorders (i.e. depression, anxiety, adjustment disorder, somatoform disorder) as a function of induced abortion, spontaneous abortion, and infertility. RESULTS The mean age was 29.2 years (SD = 6.4 years) in women with and without psychiatric disorders. Induced abortion (odds ratios [ORs] ranging from 1.75 to 2.01), spontaneous abortion (ORs ranging from 2.16 to 2.60), and infertility (OR = 2.13) were positively associated with the risk of psychiatric disorders. CONCLUSIONS A positive relationship between induced abortion, spontaneous abortion, and infertility respectively and psychiatric disorders was observed in gynecological practices in Germany.
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Affiliation(s)
- Louis Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Christian Gerhard
- Department of Gynecology and Obstetrics, Philipps University of Marburg, Marburg, Germany
| | | | - Matthias Kalder
- Department of Gynecology and Obstetrics, Philipps University of Marburg, Marburg, Germany
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Osnes RS, Roaldset JO, Follestad T, Eberhard-Gran M. Insomnia late in pregnancy is associated with perinatal anxiety: A longitudinal cohort study. J Affect Disord 2019; 248:155-165. [PMID: 30735852 DOI: 10.1016/j.jad.2019.01.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/09/2019] [Accepted: 01/20/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Postpartum anxiety (PPA) affects a substantial number of women. Despite increasing recognition of PPA, few studies have focused on perinatal anxiety and potential PPA triggers. Here we aimed to estimate the prevalence of perinatal anxiety disorders, and to explore the association between insomnia during late pregnancy and anxiety before and after childbirth. METHODS This study was part of the large population-based Akershus Birth Cohort. We analyzed data from the hospital's birth records and questionnaire responses from pregnancy weeks 17 and 32 and postpartum week 8 (n = 1563). Perinatal anxiety symptoms were measured using the Hopkins Symptom Check List. Anxiety disorder measurements were based on questions from the Mini-International Neuropsychiatric Interview. Insomnia was measured using the Bergen Insomnia Scale. RESULTS Among perinatal women, 10% reported symptoms of at least one anxiety disorder. The observed prevalence of obsessive-compulsive disorder was higher after delivery (4.2%) than during pregnancy (2.5%). Multiple regression analysis, with adjustment for several psychosocial and reproductive variables, indicated that insomnia during pregnancy was significantly associated with postpartum anxiety symptoms. However, this association was markedly weakened when depression variables were included in the analysis, indicating that gestational insomnia may also be a marker for a mood disorder. LIMITATIONS Immigrant and single women were underrepresented in our sample. CONCLUSIONS Our results suggest that anxiety disorders are prevalent during the perinatal period. Moreover, insomnia during pregnancy is associated with perinatal anxiety. Health professionals should be aware that women with gestational insomnia may have an increased risk of mood and anxiety disorders.
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Affiliation(s)
- Rannveig S Osnes
- Department of Psychiatry, Ålesund Hospital, Møre & Romsdal Health Trust, Ålesund, Norway; Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - John Olav Roaldset
- Department of Psychiatry, Ålesund Hospital, Møre & Romsdal Health Trust, Ålesund, Norway; Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Turid Follestad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Malin Eberhard-Gran
- HØKH, Research Unit, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway; Department for Infant Mental Health, Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
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Affiliation(s)
- Dinah F. Meyer
- Department of Psychology, Muskingum University, New Concord, Ohio, USA
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13
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Hartnett CS, Margolis R. Births that are Later-than-Desired: Correlates and Consequences. POPULATION RESEARCH AND POLICY REVIEW 2019. [DOI: 10.1007/s11113-019-09513-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Novak Lauš K, Tadinac M, Herman R. Anxiety During Pregnancy and Postpartum: Course, Predictors and Comorbidity with Postpartum Depression. Acta Clin Croat 2019; 57:39-51. [PMID: 30256010 DOI: 10.20471/acc.2017.56.04.05] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Previous findings on peripartum anxiety are inconsistent in respect to the prevalence and course of peripartum anxiety with comorbidity of depression. Our aim was threefold: (1) to examine the course of elevated anxiety during pregnancy, immediately after childbirth, and six weeks postpartum; (2) to establish comorbidity of postpartum anxiety and postpartum depression (PPD); and (3) to examine predictors of anxiety 6 weeks postpartum. A sample of women (N=272) who were below the cut-off score for clinical depression during pregnancy were assessed in the third trimester of pregnancy, then 2 days and 6 weeks postpartum. Questionnaires on anxiety, pregnancy specific distress, stress, coping styles, social support, and depression were administered at each assessment. Obstetric data were collected from the participants' medical records. The estimated rate of high anxiety was 35% during pregnancy, 17% immediately after childbirth, and 20% six weeks postpartum, showing a decrease in anxiety levels after childbirth. Comorbidity of anxiety and PPD was 75%. Trait anxiety and early postpartum state anxiety are significant predictors of postpartum anxiety. Anxiety is a common peripartum psychological disturbance. Anxiety symptoms overlap with PPD, but not com-pletely, indicating that screening for postpartum mental difficulties should include both depression and anxiety.
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Affiliation(s)
| | - Meri Tadinac
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
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Nakić Radoš S, Tadinac M, Herman R. Anxiety During Pregnancy and Postpartum: Course, Predictors and Comorbidity with Postpartum Depression. Acta Clin Croat 2019. [PMID: 30256010 PMCID: PMC6400346 DOI: 10.20471/acc.2018.57.01.05] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Previous findings on peripartum anxiety are inconsistent in respect to the prevalence and course of peripartum anxiety with comorbidity of depression. Our aim was threefold: (1) to examine the course of elevated anxiety during pregnancy, immediately after childbirth, and six weeks postpartum; (2) to establish comorbidity of postpartum anxiety and postpartum depression (PPD); and (3) to examine predictors of anxiety 6 weeks postpartum. A sample of women (N=272) who were below the cut-off score for clinical depression during pregnancy were assessed in the third trimester of pregnancy, then 2 days and 6 weeks postpartum. Questionnaires on anxiety, pregnancy specific distress, stress, coping styles, social support, and depression were administered at each assessment. Obstetric data were collected from the participants' medical records. The estimated rate of high anxiety was 35% during pregnancy, 17% immediately after childbirth, and 20% six weeks postpartum, showing a decrease in anxiety levels after childbirth. Comorbidity of anxiety and PPD was 75%. Trait anxiety and early postpartum state anxiety are significant predictors of postpartum anxiety. Anxiety is a common peripartum psychological disturbance. Anxiety symptoms overlap with PPD, but not com-pletely, indicating that screening for postpartum mental difficulties should include both depression and anxiety.
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Affiliation(s)
| | - Meri Tadinac
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
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16
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Yeatman S, Smith-Greenaway E. Birth Planning and Women's and Men's Health in Malawi. Stud Fam Plann 2018; 49:10.1111/sifp.12060. [PMID: 29998555 PMCID: PMC6414279 DOI: 10.1111/sifp.12060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite the frequency with which it occurs, we know little about unintended fertility in sub-Saharan Africa and even less about its implications for the health of the women and men who experience it. We use longitudinal data from southern Malawi to explore how young adults report on the planning of their births and to identify changes in their self-rated health and subjective well-being associated with having more- or less-planned births. Our data feature a comprehensive scale of pregnancy planning, the London Measure of Unplanned Pregnancy (LMUP), that extends beyond the conventional focus on timing-based pregnancy intentions to incorporate information about contraception, desires, intentions, partner discussion, and preconception preparations. Women and men have similar bimodal distributions on the LMUP, with the majority of births clearly unplanned or planned but a sizeable minority that falls in the middle. Change score models demonstrate that, for women, an unplanned birth is associated with a decline in self-rated health. In contrast, men whose births were ambivalently-planned experience a decline in subjective well-being. Our findings highlight the value of considering the full spectrum of birth planning and demonstrate the health consequences of unplanned fertility for both women and men in this sub-Saharan context.
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Affiliation(s)
- Sara Yeatman
- Department of Health and Behavioral Sciences, University of Colorado Denver
- Institute of Behavioral Science, University of Colorado Boulder
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Development of an intervention delivered by mobile phone aimed at decreasing unintended pregnancy among young people in three lower middle income countries. BMC Public Health 2018; 18:576. [PMID: 29716571 PMCID: PMC5930955 DOI: 10.1186/s12889-018-5477-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 04/18/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Unintended pregnancies can result in poorer health outcomes for women, children and families. Young people in low and middle income countries are at particular risk of unintended pregnancies and could benefit from innovative contraceptive interventions. There is growing evidence that interventions delivered by mobile phone can be effective in improving a range of health behaviours. This paper describes the development of a contraceptive behavioural intervention delivered by mobile phone for young people in Tajikistan, Bolivia and Palestine, where unmet need for contraception is high among this group. METHODS Guided by Intervention Mapping, the following steps contributed to the development of the interventions: (1) needs assessment; (2) specifying behavioural change to result from the intervention; (3) selecting behaviour change methods to include in the intervention; (4) producing and refining the intervention content. RESULTS The results of the needs assessment produced similar interventions across the countries. The interventions consist of short daily messages delivered over 4 months (delivered by text messaging in Palestine and mobile phone application instant messages in Bolivia and Tajikistan). The messages provide information about contraception, target attitudes that are barriers to contraceptive uptake and support young people in feeling that they can influence their reproductive health. The interventions each contain the same ten behaviour change methods, adapted for delivery by mobile phone. CONCLUSIONS The development resulted in a well-specified, theory-based intervention, tailored to each country. It is feasible to develop an intervention delivered by mobile phone for young people in resource-limited settings.
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Aztlan EA, Foster DG, Upadhyay U. Subsequent Unintended Pregnancy Among US Women Who Receive or Are Denied a Wanted Abortion. J Midwifery Womens Health 2018; 63:45-52. [PMID: 29377521 DOI: 10.1111/jmwh.12723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 11/21/2017] [Accepted: 11/23/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Seventeen percent of women in the United States experience more than one unintended pregnancy in their lifetimes. However, few studies examine how the resolution of unintended pregnancy, whether in birth or abortion, affects the likelihood of a subsequent unintended pregnancy. Our objective was to determine whether receiving or being denied a wanted abortion is associated with subsequent unintended pregnancy. METHODS The Turnaway Study, a 5-year, prospective cohort study, followed women who sought an abortion at one of 30 abortion facilities across the United States between 2008 and 2010. Secondary analysis of the Turnaway data analyzed the effects of various factors on time to subsequent unintended pregnancy. RESULTS By 5 years, the rate of unintended pregnancy was 42 per 100 women with no difference between those who received and those who were denied a wanted abortion. Women aged 35 to 46 years (vs those aged 20-24 years), women with a college degree (vs women who had completed high school or obtained a general education diploma), and foreign-born (vs native-born) women had a reduced rate of a subsequent unplanned pregnancy (adjusted hazard ratio [AHR], 0.30; 95% confidence interval [CI], 0.16-0.57; AHR, 0.54, 95% CI, 0.30-0.97; AHR, 0.44; 95% CI, 0.25-0.77, respectively). Higher parity and a history of depression were positively associated with a higher rate of subsequent unintended pregnancy. There was no difference in the outcomes of these unintended pregnancies by study group; approximately one-sixth ended in miscarriage and one-quarter of subsequent unintended pregnancies ended in abortion. DISCUSSION Neither receiving nor being denied abortion is associated with subsequent unintended pregnancy risk. Other factors such as nativity, parity, age, and mental health history are associated with multiple unintended pregnancies. Ensuring access to abortion services will not increase the likelihood that women will experience subsequent unintended pregnancies.
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McCarthy OL, Osorio Calderon V, Makleff S, Huaynoca S, Leurent B, Edwards P, Lopez Gallardo J, Free C. An Intervention Delivered by App Instant Messaging to Increase Acceptability and Use of Effective Contraception Among Young Women in Bolivia: Protocol of a Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e252. [PMID: 29254910 PMCID: PMC5748473 DOI: 10.2196/resprot.8679] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/20/2017] [Accepted: 11/02/2017] [Indexed: 11/17/2022] Open
Abstract
Background Unintended pregnancy is associated with numerous poorer health outcomes for both women and their children. Fulfilling unmet need for contraception is essential in avoiding unintended pregnancies, yet millions of women in low- and middle-income countries continue to face obstacles in realizing their fertility desires. In Bolivia, family planning progress has improved in recent decades but lags behind other countries in the region. Unmet need for contraception among women aged 15 to 19 years is estimated to be 38%, with the adolescent fertility rate at 70 per 1000 women. Mobile phones are an established and popular mode in which to deliver health behavior support. The London School of Hygiene & Tropical Medicine and the Centro de Investigación, Educación y Servicios in Bolivia have partnered to develop and evaluate a contraceptive behavioral intervention for Bolivian young women delivered by mobile phone. The intervention was developed guided by behavioral science and consists of short instant messages sent through an app over 4 months. Objective The objective of this study is to evaluate the effect of the intervention on young women’s use of and attitudes toward the most effective contraceptive methods. Methods We will allocate 1310 women aged 16 to 24 years with an unmet need for contraception in a 1:1 ratio to receive the intervention messages or the control messages about trial participation. The messages are sent through the Tú decides app, which contains standard family planning information. Coprimary outcomes are use and acceptability of at least one effective contraceptive method, both measured at 4 months. Results Recruitment commenced on March 1, 2017 and was completed on July 29, 2017. We estimate that the follow-up period will end in January 2018. Conclusions This trial will evaluate the effect of the intervention on young women’s use of and attitudes toward the (nonpermanent) effective contraception methods available in Bolivia. Trial Registration ClinicalTrials.gov NCT02905526; https://clinicaltrials.gov/ct2/show/NCT02905526 (Archived by WebCite at http://www.webcitation.org/6vT0yIFfN)
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Affiliation(s)
- Ona L McCarthy
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Veronica Osorio Calderon
- Centro de Investigación, Educación y Servicios - Salud Sexual Salud Reproductiva, La Paz, Bolivia
| | - Shelly Makleff
- International Planned Parenthood Federation/Western Hemisphere Region, New York, NY, United States
| | - Silvia Huaynoca
- International Planned Parenthood Federation/Western Hemisphere Region, New York, NY, United States
| | - Baptiste Leurent
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Phil Edwards
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jhonny Lopez Gallardo
- Centro de Investigación, Educación y Servicios - Salud Sexual Salud Reproductiva, La Paz, Bolivia
| | - Caroline Free
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
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20
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Cheng TS, Loy SL, Cheung YB, Godfrey KM, Gluckman PD, Kwek K, Saw SM, Chong YS, Lee YS, Yap F, Yen Chan JK, Lek N. Demographic Characteristics, Health Behaviors Before and During Pregnancy, and Pregnancy and Birth Outcomes in Mothers with Different Pregnancy Planning Status. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2017; 17:960-969. [PMID: 27577198 DOI: 10.1007/s11121-016-0694-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Studies on pregnancy intentions and their consequences have yielded mixed results. Here, we comprehensively analyzed the maternal characteristics, health behaviors before and during pregnancy, as well as pregnancy and birth outcomes, across three different pregnancy planning status in 861 women participating in an ongoing Asian mother-offspring cohort study. At 26-28 weeks' gestation, the women's intention and enthusiasm toward their pregnancy were used to classify their pregnancy into planned or unplanned, and unplanned pregnancy was further subdivided into mistimed or unintended. Data on maternal characteristics, health behaviors, and pregnancy outcomes up to that stage were recorded. After delivery, birth outcomes of the offspring were recorded. Linear and logistic regression analyses were performed. Overall, 56 % had a planned pregnancy, 39 % mistimed, and 5 % unintended. Compared to women who planned their pregnancy, women with mistimed pregnancy had higher body mass index and were more likely to have cigarette smoke exposure and less likely to have folic acid supplementation. At 26-28 weeks' gestation, unintended pregnancy was associated with increased anxiety. Neonates of mistimed pregnancy had shorter birth length compared to those of planned pregnancy, even after adjustment for maternal baseline demographics. These findings suggest that mothers who did not plan their pregnancy had less desirable characteristics or health behaviors before and during pregnancy and poorer pregnancy and birth outcomes. Shorter birth length in mistimed pregnancy may be attributed to maternal behaviors before or in the early stages of pregnancy, therefore highlighting the importance of preconception health promotion and screening for women of child-bearing age.
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Affiliation(s)
- Tuck Seng Cheng
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - See Ling Loy
- KK Research Centre, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | - Yin Bun Cheung
- Center for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore.,Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Kenneth Kwek
- Department of Maternal Foetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Seang Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yap-Seng Chong
- Department of Obstetrics & Gynaecology, Yong Loo Ling School of Medicine, National University of Singapore, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Fabian Yap
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | - Jerry Kok Yen Chan
- KK Research Centre, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore.,Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore
| | - Ngee Lek
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore
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21
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Oh S, Salas-Wright CP, Vaughn MG, DiNitto DM. Marijuana use during pregnancy: A comparison of trends and correlates among married and unmarried pregnant women. Drug Alcohol Depend 2017; 181:229-233. [PMID: 29107787 DOI: 10.1016/j.drugalcdep.2017.09.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/27/2017] [Accepted: 09/28/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND/PURPOSE While recent evidence indicates increases in marijuana use among adult women in the United States (US), important questions remain with respect to marijuana use during pregnancy. This study examines trends and correlates of prenatal marijuana use and the effects of marijuana-specific risk/protective factors on marijuana use trends using a nationally representative sample. METHOD Data were derived from the National Survey on Drug Use and Health (2005-2014), a nationally representative survey that included 3640 married and 3987 unmarried pregnant women in the United States. The significance of marijuana use trends was tested using logistic regression analyses while adjusting for complex sampling design effects and controlling for sociodemographic and marijuana-specific factors. RESULTS From 2005-2014, marijuana use prevalence among unmarried pregnant women increased by 85% from 5.4% to 10.0% while the prevalence among married pregnant women remained stable (mostly under 1.5%). The increasing trend among unmarried pregnant women was associated with their lower disapproval and risk perceptions of marijuana use. In addition, past-year anxiety (AOR=3.30, 95% CI=1.87-5.82) and depression (AOR=3.85, 95% CI=2.33-6.36) diagnoses were linked with marijuana use among unmarried, but not married, pregnant women. DISCUSSION Increased attention should be paid to reducing prenatal marijuana use among unmarried women. Findings also suggest the need to attend to unmarried pregnant women's mental health problems as well as their physical health-risk behaviors.
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Affiliation(s)
- Sehun Oh
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, United States.
| | | | - Michael G Vaughn
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, United States.
| | - Diana M DiNitto
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, United States.
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22
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McCarthy OL, Wazwaz O, Jado I, Leurent B, Edwards P, Adada S, Stavridis A, Free C. An intervention delivered by text message to increase the acceptability of effective contraception among young women in Palestine: study protocol for a randomised controlled trial. Trials 2017; 18:454. [PMID: 28974258 PMCID: PMC5627444 DOI: 10.1186/s13063-017-2191-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 09/14/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Unintended pregnancy can negatively impact women's lives and is associated with poorer health outcomes for women and children. Many women, particularly in low- and middle-income countries, continue to face obstacles in avoiding unintended pregnancy. In the State of Palestine, a survey conducted in 2006 estimated that 38% of pregnancies are unintended. In 2014, unmet need for contraception was highest among young women aged 20-24 years, at 15%. Mobile phones are increasingly being used to deliver health support. Once developed, interventions delivered by mobile phone are often cheaper to deliver than face-to-face support. The London School of Hygiene and Tropical Medicine and the Palestinian Family Planning and Protection Association have partnered to develop and evaluate a contraceptive behavioural intervention for young women in Palestine delivered by mobile phone. The intervention was developed guided by behavioural science and consists of short, mobile phone text messages that contain information about contraception and behaviour change methods delivered over 4 months. METHODS We will evaluate the intervention by conducting a randomised controlled trial. Five hundred and seventy women aged 18-24 years, who do not report using an effective method of contraception, will be allocated with a 1:1 ratio to receive the intervention text messages or control text messages about trial participation. The primary outcome is self-reported acceptability of at least one method of effective contraception at 4 months. Secondary outcomes include the use of effective contraception, acceptability of individual methods, discontinuation, service uptake, unintended pregnancy and abortion. Process outcomes include knowledge, perceived norms, personal agency and intervention dose received. Outcomes at 4 months will be compared between arms using logistic regression. DISCUSSION This trial will determine the effect of the intervention on young women's attitudes towards the most effective methods of contraception. If the intervention is found to be effective, the intervention will be implemented widely across Palestine. The results could also be used to design a larger trial to establish its effect on unintended pregnancy. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02905461 . Registered on 14 September 2016.
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Affiliation(s)
- Ona L McCarthy
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Ola Wazwaz
- Palestinian Family Planning and Protection Association, Industrial Zone, Wadi Al-Joze, Jerusalem, Palestine
| | - Iman Jado
- Palestinian Family Planning and Protection Association, Industrial Zone, Wadi Al-Joze, Jerusalem, Palestine
| | - Baptiste Leurent
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Phil Edwards
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Samia Adada
- International Planned Parenthood Federation, Arab World Regional Office, 2 Place Virgile, Notre Dame, Tunis 1082 Tunisia
| | - Amina Stavridis
- Palestinian Family Planning and Protection Association, Industrial Zone, Wadi Al-Joze, Jerusalem, Palestine
| | - Caroline Free
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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McCarthy O, Leurent B, Edwards P, Tokhirov R, Free C. A randomised controlled trial of an intervention delivered by app instant messaging to increase the acceptability of effective contraception among young people in Tajikistan: study protocol. BMJ Open 2017; 7:e017606. [PMID: 28939582 PMCID: PMC5623472 DOI: 10.1136/bmjopen-2017-017606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Women in lower income countries experience unintended pregnancies at a higher rate compared with women in higher income countries. Unintended pregnancy is associated with numerous poorer health outcomes for both women and their children. In Tajikistan, an estimated 26% of married individuals aged 15-24 years have an unmet need for contraception. The strong cultural value placed on childbearing and oppositional attitudes towards contraception are major barriers to contraceptive uptake in the country.Mobile phone ownership is widespread in Tajikistan. The option of receiving reproductive health support on your personal phone may be an appealing alternative to attending a clinic, particularly for young people. The London School of Hygiene & Tropical Medicine and the Tajik Family Planning Association have partnered to develop and evaluate a contraceptive behavioural intervention delivered by mobile phone. The intervention was developed in 2015-2016 guided by behavioural science. It consists of short instant messages sent through an app over 4 months, contains information about contraception and behaviour change methods. METHODS AND ANALYSIS This randomised controlled trial is designed to evaluate the effect of the intervention on self-reported acceptability of effective contraception at 4 months. 570 men and women aged 16-24 years will be allocated with a ratio of 1:1 to receive the intervention messages or the control messages about trial participation. The messages will be sent through the Tajik Family Planning Association's 'healthy lifestyles' app, which contains basic information about contraception. ETHICS AND DISSEMINATION The trial was granted ethical approval by the London School of Hygiene & Tropical Medicine Interventions Research Ethics Committee on 16 May 2016 and by the Tajik National Scientific and Research Centre on Paediatrics and Child Surgery on 15 April 2016. The results of the trial will be submitted for publication in peer-reviewed academic journals and disseminated to study stakeholders. TRIAL REGISTRATION NUMBER Clinicaltrial.gov NCT02905513. DATE OF REGISTRATION 14 September 2016. WHO TRIAL REGISTRATION DATASET: http://apps.who.int/trialsearch/Trial2.aspx?TrialID=NCT02905513.
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Affiliation(s)
- Ona McCarthy
- Department of Population Health, The London School of Hygiene and Tropical Medicine, London, UK
| | - Baptiste Leurent
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Phil Edwards
- Department of Population Health, The London School of Hygiene and Tropical Medicine, London, UK
| | | | - Caroline Free
- Department of Population Health, The London School of Hygiene and Tropical Medicine, London, UK
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24
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Bell MM, Newhill CE. Psychometrics of an original measure of barriers to providing family planning information: Implications for social service providers. SOCIAL WORK IN HEALTH CARE 2017; 56:556-572. [PMID: 28300481 DOI: 10.1080/00981389.2017.1296054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Social service professionals can face challenges in the course of providing family planning information to their clients. This article reports findings from a study that developed an original 27-item measure, the Reproductive Counseling Obstacle Scale (RCOS) designed to measure such obstacles based conceptually on Bandura's social cognitive theory (1986). We examine the reliability and factor structure of the RCOS using a sample of licensed social workers (N = 197). A 20-item revised version of the RCOS was derived using principal component factor analysis. Results indicate that barriers to discussing family planning, as measured by the RCOS, appear to be best represented by a two-factor solution, reflecting self-efficacy/interest and perceived professional obligation/moral concerns. Implications for practice and future research are discussed.
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Affiliation(s)
- Melissa M Bell
- a Social Work Program , Chatham University , Pittsburgh , Pennsylvania , USA
| | - Christina E Newhill
- b School of Social Work , University of Pittsburgh , Pittsburgh , Pennsylvania , USA
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25
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Multiple Unintended Pregnancies in U.S. Women: A Systematic Review. Womens Health Issues 2017; 27:407-413. [PMID: 28284587 DOI: 10.1016/j.whi.2017.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 01/26/2017] [Accepted: 02/02/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Each year, nearly one-half of all pregnancies in the United States are unintended. Risk factors of unintended pregnancy have been studied without attention to whether the pregnancy was the woman's first unintended pregnancy or whether she had had more than one. Little is known about the prevalence, incidence, and risk factors for multiple unintended pregnancies. The purpose of this paper is to present a systematic review of the extant literature on the risk factors for multiple unintended pregnancies in women in the United States, and whether these factors are specific to multiple unintended pregnancies. METHODS PubMed, PsychInfo, CINAHL, Web of Science, and JSTOR databases were searched for empirical research studies performed after 1979, in the United States, with a primary outcome of multiple unintended pregnancies. Articles that did not establish the intendedness of the studied pregnancies were excluded. RESULTS Seven studies were identified. For multiple unintended pregnancies, incidence rates ranged from 7.4 to 30.9 per 100 person-years and prevalence rates ranged from 17% to 31.6%. Greater age; identifying as Black or Hispanic; nonvoluntary first intercourse, particularly at a young age; sex trade involvement; and previous abortion were found to be associated with multiple unintended pregnancies. Use of intrauterine devices or combined oral contraceptives were found to decrease the risk of multiple unintended pregnancies. CONCLUSIONS This review suggests a small number of modifiable factors that may be used to better predict and manage multiple unintended pregnancies.
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26
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Hartnett CS, Lindley LL, Walsemann KM. Congruence across Sexual Orientation Dimensions and Risk for Unintended Pregnancy among Adult U.S. Women. Womens Health Issues 2016; 27:145-151.e2. [PMID: 28040321 DOI: 10.1016/j.whi.2016.10.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 10/25/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To date, no studies have investigated whether sexual minority women (SMW) are more likely to experience unintended pregnancies compared with their heterosexual peers. The aim of this study was to explore whether adult SMW were more likely to have unintended pregnancies compared with heterosexual women, to examine the role of identity-attraction congruence in unintended pregnancy risk, and to evaluate possible mediators. METHODS Data on pregnancies to women ages 18 to 44 were drawn from the 2006 through 2013 National Survey of Family Growth (n = 25,403). Weighted logistic regression models estimated the likelihood of reporting an unintended (rather than intended) pregnancy by identity-attraction congruence and the extent to which this association was mediated by sexual experiences with men, including age at first sex and number of sexual partners. Supplementary analyses addressed the issue of abortion underreporting. RESULTS Pregnancies to SMW were more likely to be unintended compared with pregnancies to heterosexual women (adjusted odds ratio, 1.26; 95% confidence interval, 1.08-1.46). This was driven by the elevated risk experienced by heterosexual-identified women with same-sex attractions, specifically (adjusted odds ratio, 1.28; 95% confidence interval, 1.08-1.51). Greater unintended pregnancy risk among these women was mediated by a greater number of male sex partners compared with heterosexual women. CONCLUSIONS Unintended pregnancy risk among SMW has historically received little attention from scholars and clinicians. Future research should explore the specific conditions that put heterosexual-identified women with same sex attractions at increased risk for unintended pregnancy. Clinicians should consider these dynamics when screening patients for contraceptive counseling.
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Affiliation(s)
| | - Lisa L Lindley
- Department of Global & Community Health, College of Health & Human Services, George Mason University, Fairfax, Virginia
| | - Katrina M Walsemann
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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27
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Everett BG, McCabe KF, Hughes TL. Unintended Pregnancy, Depression, and Hazardous Drinking in a Community-Based Sample of Sexual Minority Women. J Womens Health (Larchmt) 2016; 25:904-11. [PMID: 26977978 PMCID: PMC5311462 DOI: 10.1089/jwh.2015.5290] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
CONTEXT Unintended pregnancy is a stressful life event with important implications for women's health. Little research has examined sexual minority women's (SMW; lesbian, bisexual, mostly heterosexual) experiences of unintended pregnancy, and no studies have examined the relationship between unintended pregnancy, mental health, and negative coping behaviors in this population. METHODS We used the Chicago Health and Life Experiences of Women (CHLEW) Study (n = 454), a diverse sample of SMW, to examine the relationship between self-reported unintended pregnancy, depressive symptoms, and hazardous drinking. We used generalized linear model-building techniques and adjusted for key sociodemographic controls, as well as unintended pregnancy risk factors, including childhood physical and sexual abuse and age of sexual debut. RESULTS Twenty-four percent of the sample reported an unintended pregnancy. SMW who reported unintended pregnancies also reported significantly more depressive symptoms and greater risk of hazardous drinking. Adjusting for childhood abuse explained the relationship between unintended pregnancy and depressive symptoms, but not the relationship between unintended pregnancy and hazardous drinking. CONCLUSIONS Unintended pregnancy among SMW is an understudied topic. Our results suggest that unintended pregnancy is not uncommon among SMW and highlight the need for more research to investigate the mechanisms that link unintended pregnancy to depression and to hazardous drinking within this population.
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Affiliation(s)
| | - Katharine F. McCabe
- Department of Sociology, University of Illinois at Chicago, Chicago, Illinois
| | - Tonda L. Hughes
- Department of Health Systems Science, University of Illinois at Chicago, Chicago, Illinois
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Abajobir AA, Maravilla JC, Alati R, Najman JM. A systematic review and meta-analysis of the association between unintended pregnancy and perinatal depression. J Affect Disord 2016; 192:56-63. [PMID: 26707348 DOI: 10.1016/j.jad.2015.12.008] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 11/03/2015] [Accepted: 12/10/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND There is a growing interest in exploring maternal mental health effects of unintended pregnancies carried to term. However, the evidence base from a small number of available studies is characterised by considerable variability, inconsistency and inconclusive findings. We present a systematic review and meta-analysis of all available studies on unintended pregnancy as these are related to maternal depression. METHODS Using PRISMA guideline, we systematically reviewed and meta-analysed studies reporting an association between unintended pregnancy and maternal depression from PubMed, EMBASE, PsychINFO and Google Scholar. We used a priori set criteria and included details of quality and magnitude of effect sizes. Sample sizes, adjusted odds ratios and standard errors were extracted. Random effects were used to calculate pooled estimates in Stata 13. Cochran's Q, I(2) and meta-bias statistics assessed heterogeneity and publication bias of included studies. RESULTS Meta-bias and funnel plot of inverse variance detected no publication bias. Overall prevalence of maternal depression in unintended pregnancy was 21%. Unintended pregnancy was significantly associated with maternal depression. Despite statistically significant heterogeneities of included studies, sub-group analyses revealed positive and significant associations by types of unintended pregnancies, timing of measurements with respect to pregnancy and childbirth, study designs and settings. CONCLUSIONS The prevalence of perinatal depression is two-fold in women with unintended pregnancy. Perinatal care settings may screen pregnancy intention and depression of women backed by integrating family planning and mental health services.
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Affiliation(s)
| | | | - Rosa Alati
- School of Public Health, The University of Queensland, Australia; Centre for Youth Substance Abuse Research, The University of Queensland, Australia
| | - Jackob Moses Najman
- School of Public Health, The University of Queensland, Australia; School of Social Sciences, The University of Queensland, Australia
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Al-Azri M, Al-Lawati I, Al-Kamyani R, Al-Kiyumi M, Al-Rawahi A, Davidson R, Al-Maniri A. Prevalence and Risk Factors of Antenatal Depression among Omani Women in a Primary Care Setting: Cross-sectional study. Sultan Qaboos Univ Med J 2016; 16:e35-41. [PMID: 26909211 DOI: 10.18295/squmj.2016.16.01.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/10/2015] [Accepted: 12/10/2015] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES This study aimed to identify the prevalence of antenatal depression and the risk factors associated with its development among Omani women. No previous studies on antenatal depression have been conducted in Oman. METHODS This descriptive cross-sectional study was carried out between January and November 2014 in Muscat, Oman. Pregnant Omani women ≥32 gestational weeks who were attending one of 12 local primary care health centres in Muscat for routine antenatal care were invited to participate in the study (n = 986). An Arabic version of the validated self-administered Edinburgh Postnatal Depression Scale questionnaire was used to measure antenatal depression. A cut-off score of ≥13 was considered to indicate probable depression. RESULTS A total of 959 women participated in the study (response rate: 97.3%). Of these, 233 were found to have antenatal depression (24.3%). A bivariate analysis showed that antenatal depression was associated with unplanned pregnancies (P = 0.010), marital conflict (P = 0.001) and a family history of depression (P = 0.019). The adjusted odds ratio (OR) after logistic multivariate regression analysis showed that antenatal depression was significantly associated with unplanned pregnancies (OR: 1.37; 95% confidence interval [CI]: 1.02-1.86) and marital conflict (OR: 13.83; 95% CI: 2.99-63.93). CONCLUSION The prevalence of antenatal depression among the studied Omani women was high, particularly in comparison to findings from other Arab countries. Thus, antenatal screening for depression should be considered in routine primary antenatal care. Couples should also be encouraged to seek psychological support should marital conflicts develop during pregnancy.
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Affiliation(s)
- Mohammed Al-Azri
- Department of Family Medicine & Public Health, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Iman Al-Lawati
- Directorate General of Primary Health Care, Ministry of Health, Muscat, Oman
| | - Raya Al-Kamyani
- Directorate General of Primary Health Care, Ministry of Health, Muscat, Oman
| | - Maisa Al-Kiyumi
- Directorate General of Primary Health Care, Ministry of Health, Muscat, Oman
| | - Aisha Al-Rawahi
- Directorate General of Primary Health Care, Ministry of Health, Muscat, Oman
| | - Robin Davidson
- Department of Family Medicine & Public Health, Sultan Qaboos University Hospital, Muscat, Oman
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Kingsbury AM, Hayatbakhsh R, Mamun AM, Clavarino AM, Williams G, Najman JM. Trajectories and predictors of women's depression following the birth of an infant to 21 years: a longitudinal study. Matern Child Health J 2015; 19:877-88. [PMID: 25081239 DOI: 10.1007/s10995-014-1589-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Little is known about the long-term mental health of women following the birth of an infant. This study describes the 21 year trajectory of women's depression following the birth of an infant and identifies early predictors of post-birth maternal depression trajectories. The sample comprises 2,991 women from the Mater and University of Queensland Study of Pregnancy. Using the Delusions-Symptoms-States-Inventory, depression was measured at 6 months, 5, 14 and 21 years after the birth. These measures were clustered and in addition bivariate and multivariate analyses were used to test for significant association between the groups and a range of maternal socio-demographic, psychological and pregnancy-related factors. Two depression trajectories were produced, a no-low depression group (79.0 %) and a high-escalating depression group (21.0 %). The strongest predictors for a high-escalating depression group were conflict in the partner-relationship (p < 0.001), anxiety (p < 0.001) and stress (p < 0.001) in the antenatal period, having many pregnancy symptoms (p < 0.001), being younger (p < 0.001) and having poorer social networks (p < 0.001). To a lesser extent not completing high school (p < 0.05), being unsure about wanting the pregnancy (p < 0.05) and not wanting contact with the infant following the birth (p < 0.05) were also predictors for high-escalating depression trajectory. Our findings suggest a sub-sample of mothers experience persistent depressive symptoms over a 21 year period following the birth of their infant. Partner conflict, inadequate social supports and poor mental health during the pregnancy, rather than factors relating to the birth event, contribute to women's depressive symptoms in the long-term. Given the identification of early markers for persistent depression, there may be opportunities for intervention for at-risk pregnant women.
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Affiliation(s)
- Ann M Kingsbury
- School of Population Health, University of Queensland, Brisbane, QLD, Australia,
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Dutta M, Shekhar C, Prashad L. Level, Trend and Correlates of Mistimed and Unwanted Pregnancies among Currently Pregnant Ever Married Women in India. PLoS One 2015; 10:e0144400. [PMID: 26629813 PMCID: PMC4668093 DOI: 10.1371/journal.pone.0144400] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 11/17/2015] [Indexed: 11/29/2022] Open
Abstract
Unintended pregnancy accounts for more than 40% of the total pregnancies worldwide. An Unintended pregnancy can have serious implications on women and their families. With more than one-fourth of the children in India born out of unintended pregnancies such pregnancies are considered to be one of the major public health concerns today. The present study is aimed at determining major predictors of unintended pregnancy among currently pregnant ever-married women in India. The present study has used National Family Health Survey (NFHS) data, conducted by the International Institute for Population Sciences (IIPS), Mumbai, to show the trend, pattern and determinants of mistimed and unwanted pregnancies. Bivariate and multinomial logistic regression model have been used with the help of Stata 13 software. The results show that the likelihood of a mistimed pregnancy is more prevalent among young women whereas the prevalence of unwanted pregnancy is observed more among the women aged 35 years or more. The results also show that the risk of experiencing mistimed pregnancy decreases if the woman belongs to 'other' castes and has higher education. The likelihood of unwanted pregnancy decreases among married women aged 18 years and above, those women having higher education, some autonomy and access to any mode of mass communication. Knowledge of these predictors of mistimed and unwanted pregnancy will be helpful in identifying the most vulnerable group and prioritize the intervention strategies of the reproductive health programmes for the population in need.
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Affiliation(s)
- Mili Dutta
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India
| | - Chander Shekhar
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India
| | - Lokender Prashad
- School of Social Sciences, Tata Institute of Social Sciences, Mumbai, India
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Lee J, Berenson AB, Patel PR. Characteristics of Females Who Use Contraception at Coitarche: An Analysis of the National Survey of Family Growth 2006–2010 Database. J Womens Health (Larchmt) 2015; 24:972-7. [DOI: 10.1089/jwh.2015.5219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jinhyung Lee
- Department of Economics, Sungkyunkwan University, Seoul, Korea
| | - Abbey B. Berenson
- Department of Obstetrics and Gynecology, Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch in Galveston, Galveston, Texas
| | - Pooja R. Patel
- Department of Obstetrics and Gynecology, Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch in Galveston, Galveston, Texas
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Bahk J, Yun SC, Kim YM, Khang YH. Impact of unintended pregnancy on maternal mental health: a causal analysis using follow up data of the Panel Study on Korean Children (PSKC). BMC Pregnancy Childbirth 2015; 15:85. [PMID: 25881099 PMCID: PMC4387588 DOI: 10.1186/s12884-015-0505-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 03/17/2015] [Indexed: 11/18/2022] Open
Abstract
Background Pregnancy intention is important for maternal and child health outcomes. The purpose of this study was to examine the causal relation between pregnancy intention and maternal depression and parenting stress in Korean women who gave birth during 2008. Methods This study is a retrospective evaluation of prospectively collected data from the Panel Study on Korean Children from 2008 to 2010. Causal analyses were conducted using propensity score matching and inverse probability of treatment weighted methods. In addition, mediation analyses were performed to test mitigating effects of marital conflict, fathers’ participation in childcare, and mothers’ knowledge of infant development on the relation between unintended pregnancy and adverse maternal mental health. Results Results showed that the overall effect of an unintended pregnancy on maternal depression and parenting stress was statistically significant. An unintended pregnancy was associated with 20–22% greater odds of maternal depression, 0.28–0.39 greater depression score, and 0.85–1.16 greater parenting stress score. Relations between pregnancy intention and maternal depression, maternal depression score and parenting stress score were moderately explained by marital conflict and fathers’ participation in childcare. Conclusions Unintended pregnancy contributed to increased risks of maternal depression and parenting stress. Efforts to increase fathers’ participation in childcare and decrease marital conflict might be helpful to mitigate adverse impacts of unintended pregnancy on perinatal maternal mental health. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0505-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jinwook Bahk
- Institute of Health Policy and Management, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea.
| | - Sung-Cheol Yun
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-2dong Songpa-gu, Seoul, 138-736, South Korea.
| | - Yu-mi Kim
- Department of Preventive Medicine, Dong-A University College of Medicine, 26 Daesingongwon-ro, Seo-gu, Busan, 602-715, South Korea.
| | - Young-Ho Khang
- Institute of Health Policy and Management, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea. .,Department of Health Policy and Management, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea.
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Exavery A, Kanté AM, Njozi M, Tani K, Doctor HV, Hingora A, Phillips JF. Predictors of mistimed, and unwanted pregnancies among women of childbearing age in Rufiji, Kilombero, and Ulanga districts of Tanzania. Reprod Health 2014; 11:63. [PMID: 25102924 PMCID: PMC4130430 DOI: 10.1186/1742-4755-11-63] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 08/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While unintended pregnancies pose a serious threat to the health and well-being of families globally, characteristics of Tanzanian women who conceive unintentionally are rarely documented. This analysis identifies factors associated with unintended pregnancies-both mistimed and unwanted-in three rural districts of Tanzania. METHODS A cross-sectional survey of 2,183 random households was conducted in three Tanzanian districts of Rufiji, Kilombero, and Ulanga in 2011 to assess women's health behavior and service utilization patterns. These households produced 3,127 women age 15+ years from which 2,199 gravid women aged 15-49 were selected for the current analysis. Unintended pregnancies were identified as either mistimed (wanted later) or unwanted (not wanted at all). Correlates of mistimed, and unwanted pregnancies were identified through Chi-squared tests to assess associations and multinomial logistic regression for multivariate analysis. RESULTS Mean age of the participants was 32.1 years. While 54.1% of the participants reported that their most recent pregnancy was intended, 32.5% indicated their most recent pregnancy as mistimed and 13.4% as unwanted. Multivariate analysis revealed that young age (<20 years), and single marital status were significant predictors of both mistimed and unwanted pregnancies. Lack of inter-partner communication about family planning increased the risk of mistimed pregnancy significantly, and multi-gravidity was shown to significantly increase the risk of unwanted pregnancy. CONCLUSIONS About one half of women in Rufiji, Kilombero, and Ulanga districts of Tanzania conceive unintentionally. Women, especially the most vulnerable should be empowered to avoid pregnancy at their own will and discretion.
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Affiliation(s)
- Amon Exavery
- Ifakara Health Institute, Plot 463, Kiko Avenue, Mikocheni, P,O Box 78373, Dar es Salaam, Tanzania.
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Ayoola AB, Zandee GL, Johnson E, Pennings K. Contraceptive use among low-income women living in medically underserved neighborhoods. J Obstet Gynecol Neonatal Nurs 2014; 43:455-64. [PMID: 24958447 DOI: 10.1111/1552-6909.12462] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To describe the rate of contraceptive use and types of contraception used by low-income women. DESIGN A descriptive study was used to survey women about their contraceptive use and sexual behaviors 12 months prior to the time of the interview. PARTICIPANTS AND SETTING A convenience sample of 110 low-income women living in three urban medically underserved neighborhoods who enrolled in a larger study was included. METHODS Univariate and bivariate descriptive analyses were conducted using STATA 10. RESULTS Forty-eight (43.6%) of the women were African American, 43 (39.1%) were Hispanic, and 17 (15.5%) were White. The women were age 18 to 55 years (Mean = 31 years). Forty percent of these women who were not pregnant or planning to get pregnant had sex without contraceptives in the past 12 months. The percentage of women who used contraception decreased from 77.3% users in the last 12 months to 63.6% current users. The most common methods used within the last 12 months were condom use by male partner (28.2%), birth control pills (14.6%), contraceptive injection (12.7%), intrauterine device (10.9%), and the patch (1.8%). CONCLUSIONS Many of the low-income women from medically underserved neighborhoods did not use contraceptives and of those who used contraceptives, the majority used the least effective methods.
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Exavery A, Kanté AM, Njozi M, Tani K, Doctor HV, Hingora A, Phillips JF. Access to institutional delivery care and reasons for home delivery in three districts of Tanzania. Int J Equity Health 2014; 13:48. [PMID: 24934657 PMCID: PMC4069087 DOI: 10.1186/1475-9276-13-48] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 06/07/2014] [Indexed: 11/13/2022] Open
Abstract
Introduction Globally, health facility delivery is encouraged as a single most important strategy in preventing maternal and neonatal morbidity and mortality. However, access to facility-based delivery care remains low in many less developed countries. This study assesses facilitators and barriers to institutional delivery in three districts of Tanzania. Methods Data come from a cross-sectional survey of random households on health behaviours and service utilization patterns among women and children aged less than 5 years. The survey was conducted in 2011 in Rufiji, Kilombero, and Ulanga districts of Tanzania, using a closed-ended questionnaire. This analysis focuses on 915 women of reproductive age who had given birth in the two years prior to the survey. Chi-square test was used to test for associations in the bivariate analysis and multivariate logistic regression was used to examine factors that influence institutional delivery. Results Overall, 74.5% of the 915 women delivered at health facilities in the two years prior to the survey. Multivariate analysis showed that the better the quality of antenatal care (ANC) the higher the odds of institutional delivery. Similarly, better socioeconomic status was associated with an increase in the odds of institutional delivery. Women of Sukuma ethnic background were less likely to deliver at health facilities than others. Presence of couple discussion on family planning matters was associated with higher odds of institutional delivery. Conclusion Institutional delivery in Rufiji, Kilombero, and Ulanga district of Tanzania is relatively high and significantly dependent on the quality of ANC, better socioeconomic status as well as between-partner communication about family planning. Therefore, improving the quality of ANC, socioeconomic empowerment as well as promoting and supporting inter-spousal discussion on family planning matters is likely to enhance institutional delivery. Programs should also target women from the Sukuma ethnic group towards universal access to institutional delivery care in the study area.
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Affiliation(s)
- Amon Exavery
- Ifakara Health Institute, Plot 463, Kiko Avenue, Off Mwai Kibaki Road, Mikocheni, P,O, Box 78373, Dar es Salaam, Tanzania.
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East PL, Barber JS. High Educational Aspirations Among Pregnant Adolescents Are Related to Pregnancy Unwantedness and Subsequent Parenting Stress and Inadequacy. JOURNAL OF MARRIAGE AND THE FAMILY 2014; 76:652-664. [PMID: 25641985 PMCID: PMC4307620 DOI: 10.1111/jomf.12103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 12/12/2013] [Indexed: 06/04/2023]
Abstract
On the basis of theories of maternal identity development, role conflict, and childbearing motivation, the authors tested whether high educational aspirations among pregnant adolescents are related to the unwantedness of the pregnancy and whether pregnancy unwantedness leads to subsequent parenting stress and inadequacy. Longitudinal data from 100 first-time-pregnant, unmarried Latina adolescents (M age = 17.3 years) were analyzed. Results from structural equation path modeling confirmed these associations, with strong educational ambitions related to greater unwantedness of the pregnancy, which led to feeling trapped by parenting at 6 months postpartum, which in turn was related to unaffectionate parenting and feeling inadequate in mothering at 1 year postpartum. The potential long-term negative consequences of high educational aspirations for pregnant adolescents' adjustment to parenting are discussed.
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Affiliation(s)
- Patricia L East
- Department of Pediatrics, Division of Child Development and Community Health, University of California, San Diego, 9500 Gilman Dr., Mail Code 0927, La Jolla, CA 92093-0927, ( )
| | - Jennifer S Barber
- Department of Sociology, University of Michigan, 426 Thompson St., Ann Arbor, MI 48106-1248
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Poçan AG, Aki OE, Parlakgümüs AH, Gereklioglu C, Dolgun AB. The incidence of and risk factors for postpartum depression at an urban maternity clinic in Turkey. Int J Psychiatry Med 2014; 46:179-94. [PMID: 24552041 DOI: 10.2190/pm.46.2.e] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Postpartum depression (PPD) is an important health issue that affects not only mothers, but also entire families. Postpartum follow-up should address emotional and psychological issues, as well as physical issues, especially in those at risk. This study aimed to determine the incidence of PPD and the associated risk factors in a group of new mothers undergoing routine follow-up at an urban maternity clinic. METHODS This is a cross-sectional study investigating the relationship between PPD and various factors. A total of 187 women that presented to a university hospital for routine postpartum follow-up 4-6 weeks post delivery were recruited consecutively. The mothers were administered a sociodemographic form that included questions about the known risk factors (sociodemographic and sociocultural factors, and mother-related, pregnancy-related, and child-related factors) and the Edinburgh Postnatal Depression Scale (EPDS). RESULTS The incidence of PPD based on EPDS scores was 28.9% (scores > 12 were defined as PPD). Unplanned/unintended pregnancy, bottle-feeding only, mother's lack of satisfaction with the baby's sleep pattern, lack of family support for baby care, lack of satisfaction with the marital relationship, and family violence were significantly correlated with PPD (P < 0.05). Multiple logistic regression showed that bottle-feeding, lack of family support, lack of satisfaction with the marital relationship, and family violence were the primary factors that significantly increased the risk of PPD. CONCLUSIONS The findings show that the PPD occurs in almost one-third of women and that, among the risk factors, sociocultural factors were the most strongly associated with PPD.
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Rodríguez MI, Say L, Temmerman M. Family planning versus contraception: what's in a name? LANCET GLOBAL HEALTH 2014; 2:e131-2. [PMID: 25102839 DOI: 10.1016/s2214-109x(13)70177-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Schmied V, Johnson M, Naidoo N, Austin MP, Matthey S, Kemp L, Mills A, Meade T, Yeo A. Maternal mental health in Australia and New Zealand: A review of longitudinal studies. Women Birth 2013; 26:167-78. [DOI: 10.1016/j.wombi.2013.02.006] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 01/03/2013] [Accepted: 02/12/2013] [Indexed: 10/26/2022]
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Abbasi S, Chuang CH, Dagher R, Zhu J, Kjerulff K. Unintended pregnancy and postpartum depression among first-time mothers. J Womens Health (Larchmt) 2013; 22:412-6. [PMID: 23488527 PMCID: PMC3701312 DOI: 10.1089/jwh.2012.3926] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Postpartum depression is a mental disorder that occurs after birth and has negative consequences for the mother, infant, and family. The objective of this secondary analysis was to examine whether pregnancy intention was associated with postpartum depression among first-time mothers. METHODS The First Baby Study is a prospective cohort study of women aged 18-35 having a first singleton birth in Pennsylvania. Baseline data were collected during the third trimester. Postpartum depressive symptoms were measured at 1-month postpartum using the Edinburgh Postnatal Depression Scale. Logistic regression was performed to examine the association between unintended pregnancy and postpartum depression, controlling for prepregnancy anxiety/depression and sociodemographic data. RESULTS Of 2972 first-time mothers, 83.4% were white, 70.7% were married, and 56.9% were college educated. Nine hundred fifty-two women (32.0%) reported their pregnancy was unintended and 151 (5.1%) met the threshold for postpartum depression. The prevalence of postpartum depression was higher in women with unintended pregnancies compared to women with intended pregnancies (6.7% vs. 4.3%, p<0.01). However, after controlling for confounders, unintended pregnancy was no longer associated with postpartum depression (adjusted OR 1.41; 95% CI 0.91-2.18). Variables independently associated with postpartum depression included prepregnancy anxiety/depression, Asian race, and Hispanic ethnicity. CONCLUSION Pregnancy intention was not independently associated with postpartum depression among first time mothers in Pennsylvania.
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Affiliation(s)
- Shahed Abbasi
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania 17033, USA
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McCrory C, McNally S. The effect of pregnancy intention on maternal prenatal behaviours and parent and child health: results of an irish cohort study. Paediatr Perinat Epidemiol 2013; 27:208-15. [PMID: 23374066 DOI: 10.1111/ppe.12027] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Unintended pregnancy is associated with increased risk for adverse neonatal and early childhood outcomes spanning an array of indicators, but it remains unclear whether these risks hold independent of other biological, social and environmental risk factors. METHODS This study uses data from the first wave of the 'Growing Up in Ireland Study', a large nationally representative cohort study of more than 11 000 infants, to examine the risk factors associated with unintended pregnancy. Adopting a staged approach to the analysis, the study investigates whether pregnancy intention influences maternal health behaviours during pregnancy independent of background characteristics, and whether pregnancy intention carries any additional risk for adverse infant and maternal health outcomes when we adjust for background characteristics and prenatal behaviours. RESULTS The study confirmed that sociodemographic factors are strongly associated with unintended pregnancy and that unintended pregnancy is associated with a range of health compromising behaviours that are known to be harmful to the developing fetus. While there was little evidence to suggest that pregnancy intention was associated with adverse neonatal outcomes or developmental delay independent of other covariates, there was strong evidence that intention status had a bearing on the mother's psychosocial health. Unintended pregnancy was associated with increased risk of depression (risk ratio 1.36 [95% confidence interval 1.19, 1.54]), and higher parenting stress (risk ratio 1.27 [95% confidence interval 1.16, 1.38]). CONCLUSIONS Ascertaining the mother's pregnancy intention during the first antenatal visit may represent a means for monitoring those at greatest risk for adverse mother and child outcomes.
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Affiliation(s)
- Cathal McCrory
- The Irish Longitudinal Study on Ageing, Department of Medical Gerontology, Trinity College Dublin, Ireland.
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Exavery A, Kanté AM, Hingora A, Mbaruku G, Pemba S, Phillips JF. How mistimed and unwanted pregnancies affect timing of antenatal care initiation in three districts in Tanzania. BMC Pregnancy Childbirth 2013; 13:35. [PMID: 23388110 PMCID: PMC3574825 DOI: 10.1186/1471-2393-13-35] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 01/30/2013] [Indexed: 11/17/2022] Open
Abstract
Background Early antenatal care (ANC) initiation is a doorway to early detection and management of potential complications associated with pregnancy. Although the literature reports various factors associated with ANC initiation such as parity and age, pregnancy intentions is yet to be recognized as a possible predictor of timing of ANC initiation. Methods Data originate from a cross-sectional household survey on health behaviour and service utilization patterns. The survey was conducted in 2011 in Rufiji, Kilombero and Ulanga districts in Tanzania on 3,127 women from whom 910 of reproductive age who had given birth in the past two years and sought ANC at least once during pregnancy were selected for the current analysis. ANC initiation was considered to be early only if it occurred in the first trimester of pregnancy gestation. A recently completed pregnancy was defined as mistimed if a woman wanted it later, and if she did not want it at all the pregnancy was termed as unwanted. Chi-square was used to test for associations and multinomial logistic regression was conducted to examine how mistimed and unwanted pregnancies relate with timing of ANC initiation. Results Although 49.3% of the women intended to become pregnant, 50.7% (34.9% mistimed and 15.8% unwanted) became pregnant unintentionally. While ANC initiation in the 1st trimester was 18.5%, so was 71.7% and 9.9% in the 2nd and 3rd trimesters respectively. Multivariate analysis revealed that ANC initiation in the 2nd trimester was 1.68 (95% CI 1.10–2.58) and 2.00 (95% CI 1.05–3.82) times more likely for mistimed and unwanted pregnancies respectively compared to intended pregnancies. These estimates rose to 2.81 (95% CI 1.41–5.59) and 4.10 (95% CI 1.68–10.00) respectively in the 3rd trimester. We controlled for gravidity, age, education, household wealth, marital status, religion, district of residence and travel time to a health facility. Conclusion Late ANC initiation is a significant maternal and child health consequence of mistimed and unwanted pregnancies in Tanzania. Women should be empowered to delay or avoid pregnancies whenever they need to do so. Appropriate counseling to women, especially those who happen to conceive unintentionally is needed to minimize the possibility of delaying ANC initiation.
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Affiliation(s)
- Amon Exavery
- Ifakara Health Institute (IHI), Plot 463, Kiko Avenue, off Old Bagamoyo Road, Mikocheni, P,O, Box 78373, Dar es Salaam, Tanzania.
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de Bocanegra HT, Maguire F, Hulett D, Horsley K, Puffer M, Brindis CD. Enhancing service delivery through title x funding: findings from California. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2012; 44:262-269. [PMID: 23231334 DOI: 10.1363/4426212] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
CONTEXT The federal Title X grant program provides funding for family planning services for low-income women and men. In California, all clinics receiving Title X funds participate in the state's family planning program, Family PACT, along with other public and private providers. The relative extent to which Title X-funded clinics and other Family PACT providers have incorporated enhancements beyond their core medical services has never been studied. METHODS In 2010, a survey was sent to public- and private-sector Family PACT clinicians to assess whether funding streams were associated with the availability of special services: extended clinic hours, outreach to vulnerable populations, services for clients not proficient in English and use of advanced clinic-based technologies. Bivariate and logistic regression analyses controlling for potentially confounding factors were conducted. RESULTS Greater proportions of Title X-funded clinics than of other public and private providers had Spanish-speaking unlicensed clinical staff (89% vs. 71% and 58%, respectively) and Spanish-language signs (95% vs. 85% and 82%). Title X-funded providers were more likely than other public providers to offer extended clinic hours, provide outreach to at least three vulnerable or hard-to-reach populations, and use three or more advanced technologies (odds ratios, 2.0-2.9). CONCLUSIONS Compared with other Family PACT providers, clinics that receive Title X funding have implemented greater infrastructure enhancements to promote access and improve the quality of service for underserved populations. This may be because Title X-funded providers have more financial opportunities to provide the array of services that best respond to their clients' needs.
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Kingston D, Heaman M, Fell D, Dzakpasu S, Chalmers B. Factors associated with perceived stress and stressful life events in pregnant women: findings from the Canadian Maternity Experiences Survey. Matern Child Health J 2012; 16:158-68. [PMID: 21165763 DOI: 10.1007/s10995-010-0732-2] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Prenatal maternal stress has been linked to multiple adverse outcomes. Researchers have used a variety of methods to assess maternal stress. The purpose of this study was to explore and compare factors associated with stress in pregnancy as measured by perceived stress and stressful life events. We analyzed data from the Canadian Maternity Experiences Survey. A randomly selected sample of 8,542 women who had recently given birth was drawn from the 2006 Canadian Census. Women were eligible if they were at least 15 years of age, had delivered a live, singleton infant, and were living with their infant at the time of the interview (5-14 months postpartum). Prevalence estimates and odds ratios were calculated using sample weights of the survey and their variances were calculated using bootstrapping methods. Bivariate analyses identified statistically significant factors associated with each stress measure. Backward stepwise multivariate logistic regression models were constructed. A total of 6,421 women (78%) participated in the computer assisted telephone interview. Twelve percent of women experienced high levels of perceived stress and 17.1% reported having three or more stressful life events in the year prior to the birth of their baby. In the final model, psychosocial variables were associated with both outcomes, whereas demographic factors were associated only with life event stress. Different factors contributed to perceived stress and life event stress, suggesting that these concepts measure different aspects of stress. These findings can inform routine psychosocial risk assessment in pregnancy.
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Affiliation(s)
- Dawn Kingston
- Faculty of Nursing, University of Manitoba, Helen Glass Centre for Nursing, Winnipeg, MB R3T 2N2, Canada.
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Christensen AL, Stuart EA, Perry DF, Le HN. Unintended pregnancy and perinatal depression trajectories in low-income, high-risk Hispanic immigrants. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2011; 12:289-99. [PMID: 21537899 DOI: 10.1007/s11121-011-0213-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Perinatal depression is a prevalent and detrimental condition. Determining modifiable factors associated with it would identify opportunities for prevention. This paper: 1) identifies depressive symptom trajectories and heterogeneity in those trajectories during pregnancy through the first-year postpartum, and 2) examines the association between unintended pregnancy and depressive symptoms. Depressive symptoms (BDI-II) were collected from low-income Hispanic immigrants (n=215) five times from early pregnancy to 12-months postpartum. The sample was at high-risk for perinatal depression and recruited from two prenatal care settings. Growth mixture modeling (GMM) was used to identify distinct trajectories of depressive symptoms over the perinatal period. Multinomial logistic regression was then conducted to examine the association between unintended pregnancy (reported at baseline) and the depression trajectory patterns. Three distinct trajectory patterns of depressive symptoms were identified: high during pregnancy, but low postpartum ("Pregnancy High": 9.8%); borderline during pregnancy, with a postpartum increase ("Postpartum High": 10.2%); and low throughout pregnancy and postpartum ("Perinatal Low": 80.0%). Unintended pregnancy was not associated with the "Pregnancy High" pattern, but was associated with a marginally significant nearly four fold increase in risk of the "Postpartum High" pattern in depressive symptoms (RRR=3.95, p<0.10). Family planning is a potential strategy for the prevention of postpartum depression. Women who report unintended pregnancies during prenatal care must be educated of their increased risk, even if they do not exhibit antenatal depressive symptoms. Routine depression screening should occur postpartum, and referral to culturally appropriate treatment should follow positive screening results.
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Affiliation(s)
- Anna L Christensen
- Mathematica Policy Research, 600 Maryland Ave, SW, Suite 550, Washington, DC 20024, USA.
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State-level women's status and psychiatric disorders among US women. Soc Psychiatry Psychiatr Epidemiol 2011; 46:1161-71. [PMID: 20853099 PMCID: PMC3465704 DOI: 10.1007/s00127-010-0286-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 09/02/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Although greater gender equality at the state-level is associated with fewer depressive symptoms in women after controlling for individual-level confounders, the extent to which state-level women's status is related to psychiatric disorders in women and gender differences in psychopathology has never been examined. We examined these associations in the current report. METHODS We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (n=34,653), a national probability sample of US adults. Respondents completed structured diagnostic assessments of DSM-IV psychiatric disorders. We used generalized estimating equations to examine associations between four state-level indicators of women's status (political participation, employment/earnings, social/economic autonomy, and reproductive rights) and odds of 12-month mood and anxiety disorders among women. We also tested whether women's status predicted the magnitude of gender differences in psychiatric disorders. RESULTS State-level political participation, employment/earnings, and social/economic autonomy were unrelated to odds of 12-month mood and anxiety disorders among women. However, the prevalence of major depression and post-traumatic stress disorder was lower in states where women have greater reproductive rights (OR 0.93-0.95), controlling for individual-level risk factors. None of the women's status indicators predicted gender differences in mood and anxiety disorder prevalence. CONCLUSIONS State-level women's status was largely unrelated to mood and anxiety disorders in women or to gender differences in these disorders. Investigation of social factors that play a role in shaping the distribution of individual-level risk factors that are associated with gender disparities in psychiatric disorders represents an important avenue for future research.
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Carlson D, Williams K. Parenthood, Life Course Expectations, and Mental Health. SOCIETY AND MENTAL HEALTH 2011; 1:20-40. [PMID: 22229115 PMCID: PMC3249830 DOI: 10.1177/2156869310394541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Although past research indicates that early and premarital childbearing negatively affect mental health, little is known about the role of individual expectations in shaping these associations. Using data from the National Longitudinal Survey of Youth 1979, we consider how individual expectations, measured prior to the entry into parenthood, shape mental health outcomes associated with premarital childbearing and birth timing, and consider gender and race/ethnic variations. Results indicate that expecting children before marriage ameliorates the negative mental health consequences of premarital first births and that subsequently deviating from expected birth timing, either early or late, results in increased distress at all birth ages. In both cases, however, the degree and manner in which expectations matter differ by gender and race/ethnicity. Results indicate that expectations for premarital childbearing matter only for African-Americans' mental health and although later than expected births are associated with decreased mental health for all groups, earlier than expected births are only associated with decreased mental health for women, Hispanics, and non-Hispanic whites.
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Abstract
This study examines whether children with a younger sibling whose birth was unintended experience larger declines in the quality of their home environment and larger increases in behavioral problems than children whose younger sibling's birth was intended. We use data from the NLSY79 to estimate cross-lag regression models that assess changes in the home environment and children's behavioral problems after the birth of a sibling (intended or unintended). Results are consistent with our hypotheses, finding that, indeed, unintended births have negative spillover effects. Compared with children whose sibling's birth was intended, both boys and girls whose sibling's birth was unintended experienced larger declines in the quality of their home environment, and boys had larger increases in behavioral problems. We also find some unexpected evidence that mistimed births may have larger negative effects than unwanted births. This deserves further research, and we offer some possible explanations that could guide those investigations.
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Affiliation(s)
- Jennifer S. Barber
- Department of Sociology, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48106-1248, USA
| | - Patricia L. East
- Department of Pediatrics, University of California, San Diego, CA, USA
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