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Ståhl A, Salonen M, Hakanen E, Mikkola S, Sulkama S, Lahti J, Lohi H. Development and validation of the puppy blues scale measuring temporary affective disturbance resembling baby blues. NPJ MENTAL HEALTH RESEARCH 2024; 3:27. [PMID: 38849543 PMCID: PMC11161525 DOI: 10.1038/s44184-024-00072-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/30/2024] [Indexed: 06/09/2024]
Abstract
It has been described that many puppy owners experience a state called puppy blues involving stress, worry, anxiety, strain, frustration, or regret. While puppy blues is a commonly used term among dog owners, the term is nearly nonexistent in scientific literature. In turn, analogous phenomenon, postpartum affective disturbance of infant caregivers, is well described in the literature. This study aimed to develop and validate the first questionnaire to evaluate puppy blues. The methodology involved generating scale items based on a qualitative review of 135 pilot survey responses from people who had experienced distress during the puppy period, conducting exploratory factor analysis for the final scale items from a dataset of 1801 answers from Finnish dog owners (92% women), and collecting test-retest data from 265 individuals to assess the consistency of the measurement of items and factor structure across time. In addition, we collected an independent sample of 326 owners of 1-2-year-old dogs who answered the survey both regarding puppy period and current moment. The results indicate that the scale is a valid and reliable tool for measuring dog owners' negative experiences and feelings related to puppyhood. We discovered three factors that describe different aspects of puppy blues: Frustration, Anxiety, and Weariness, which accounted for a significant proportion of the variance in puppy blues. The study demonstrated good internal consistency and consistency across two independent samples for the three identified factors. The test-retest reliability of the factors was good. Responses for the current timeframe compared to puppyhood experiences revealed significantly lower current scores across all factors for the current period, validating that the scale captures distress during puppyhood that diminishes over time. Interestingly, we found a fading affect bias where recollections of the experiences in the puppy period became more positive with time. Our findings shed light on the characteristics of puppy blues and provide a useful retrospective tool for measuring it.
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Affiliation(s)
- Aada Ståhl
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland.
- Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland.
- Folkhälsan Research Center, Helsinki, Finland.
| | - Milla Salonen
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
- Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Department of Biology, University of Turku, Turku, Finland
| | - Emma Hakanen
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
- Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Salla Mikkola
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
- Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Sini Sulkama
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
- Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Jari Lahti
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Hannes Lohi
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland.
- Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland.
- Folkhälsan Research Center, Helsinki, Finland.
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Müller R, Lake M, Krstić N, Običan SG, Cragun D. Impact of perinatal exposure counseling on patient reported emotional outcomes and decisional empowerment. Birth Defects Res 2024; 116:e2325. [PMID: 38520213 DOI: 10.1002/bdr2.2325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Exposures during pregnancy are common and most pregnant patients utilize at least one medication during pregnancy. The lack of reliable information on medication safety during pregnancy available to providers and patients is a stressor and obstacle to decision-making about medication use in pregnancy. Previous studies showed that exposures in pregnancy are associated with guilt, worry, and decisional conflict. Although prior research has evaluated changes in patient knowledge after teratogen counseling, studies have not examined emotional outcomes or patients' decisional empowerment. This quasi-experimental study measured changes in patients' feelings of guilt, anxiety, and decisional empowerment after receiving exposure counseling from trained teratogen information specialists. METHODS We administered pre- and post-counseling surveys to patients referred to a perinatal exposure clinic in Tampa, Florida. Validated scales were used to measure anxiety and guilt, and the 'SURE' measure was used to assess decisional empowerment. Paired samples t-tests evaluated changes in anxiety and guilt and a McNemar test assessed for changes in empowered decision making. RESULTS Among the 34 participants who completed both surveys, anxiety, and guilt scores decreased significantly (p < .001). While only 21% felt informed and empowered to make a decision related to their exposure(s) before counseling, this increased to 85% (p < .001) on the post-survey. CONCLUSION Comprehensive counseling with a trained teratogen information specialist improves patient emotional outcomes as well as feelings of empowerment to make an informed decision regarding medication use in pregnancy. This study highlights that patient-centered teratogen counseling goes beyond simple changes in patient knowledge.
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Affiliation(s)
- Réka Müller
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, USA
| | - Madison Lake
- Division of Genetics and Metabolism, University of Florida, USA
| | - Nevena Krstić
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, USA
| | - Sarah G Običan
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, USA
| | - Deborah Cragun
- College of Public Health, University of South Florida, USA
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Duloxetine Exposure During Pregnancy and the Risk of Offspring Being Born Small for Gestational Age or Prematurely: A Nationwide Danish and Swedish Safety Study. Drugs Real World Outcomes 2022; 10:69-81. [PMID: 36355315 PMCID: PMC9943795 DOI: 10.1007/s40801-022-00334-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Depression or depressive symptoms are common among pregnant women. The use of antidepressants during pregnancy has grown steadily. The risk of offspring being born small for gestational age or prematurely when exposed to duloxetine during pregnancy is not established. OBJECTIVE We aimed to investigate the association between duloxetine exposure during pregnancy and offspring being born small for gestational age or prematurely. METHODS We conducted an observational study including live births in Sweden and Denmark (2004-2016). Duloxetine exposure during early (0-140 days) or late (141 to delivery) pregnancy compared with duloxetine-non-exposed, selective serotonin reuptake inhibitor-exposed, venlafaxine-exposed, and duloxetine discontinuers. RESULTS In total, 2,083,467 pregnancies were identified, where 1589 and 450 were duloxetine exposed in early and late pregnancy, respectively. For small for gestational age, no increased risk was seen for duloxetine across comparators. In the early and late exposure windows, propensity score-matched odds ratios for small for gestational age ranged between 0.64 (95% confidence interval 0.44-0.95) and 1.48 (95% confidence interval 0.85-2.57). For preterm birth, the findings differed across comparators and exposure-time windows, but trended towards an increased risk for duloxetine-exposed when compared with duloxetine-non-exposed, selective serotonin reuptake inhibitor-exposed, and duloxetine discontinuers in both early exposure and late exposure. The odds ratios ranged between 1.17 and 2.04, of which some did not reach statistical significance. No clear association was observed when compared with venlafaxine exposed, 0.91 (95% confidence interval 0.73-1.14) for early exposure and 1.26 (95% confidence interval 0.86-1.86) for late exposure. Most preterm births (79.2%) occurred in weeks 33-36 of gestation. CONCLUSIONS Duloxetine exposure during pregnancy is unlikely to increase the risk of small for gestational age. Although not consequently statistically significant across comparisons, a trend towards an increased risk of preterm birth was observed for duloxetine exposed. Therefore, an increased risk of preterm birth cannot be excluded, especially for women exposed to duloxetine throughout pregnancy.
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Pontoppidan M, Nygaard L, Thorsager M, Friis-Hansen M, Davis D, Nohr EA. The FACAM study: protocol for a randomized controlled study of an early interdisciplinary intervention to support women in vulnerable positions through pregnancy and the first 5 years of motherhood. Trials 2022; 23:73. [PMID: 35073975 PMCID: PMC8785506 DOI: 10.1186/s13063-022-06022-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Inequality in health can have profound short- and long-term effects on a child's life. Infants develop in a responsive environment, and the relationship between mother and infant begins to develop during pregnancy. The mother's ability to bond with the fetus and newborn child may be challenged by mental health issues which can cause impaired functioning and poorer health outcomes. Families with complex problems need interdisciplinary interventions starting in early pregnancy to be prepared for motherhood and to ensure healthy child development. This study aims to examine the effects of an early and coordinated intervention (the Family Clinic and Municipality (FACAM) intervention) offered to vulnerable pregnant women during pregnancy and the child's first year of life on the mother-child relationship, maternal social functioning, mental health, reflective functioning, well-being, parental stress, and the development and well-being of the child. METHODS The study is a prospective randomized controlled trial where we will randomize 320 pregnant women enrolled to receive antenatal care at the family clinic at Odense University Hospital, to either FACAM intervention or usual care. The FACAM intervention consists of extra support by a health nurse or family therapist during pregnancy and until the child starts school. The intervention is most intensive in the first 12 months and also includes attachment-based support provided either individually or in groups. The participants are assessed at baseline, and when the infant is 3 and 12 months old. The primary outcome is maternal sensitivity measured by the Coding Interactive Behavior (CIB) instrument. Secondary outcomes include prenatal parental reflective functioning, mental well-being, depressive symptoms, breastfeeding duration, maternal satisfaction, child development, parent competence, parental stress, and activities with the child. DISCUSSION The trial is expected to contribute knowledge about the effect of early coordinated support in antenatal and postnatal care for vulnerable pregnant women and their families. TRIAL REGISTRATION ClinicalTrials.gov NCT03659721 . Registered on September 6, 2018.
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Affiliation(s)
- Maiken Pontoppidan
- VIVE - The Danish Centre for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark.
| | - Lene Nygaard
- University of Canberra and ACT Health, Bruce, Australia
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mette Thorsager
- VIVE - The Danish Centre for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark
| | - Mette Friis-Hansen
- VIVE - The Danish Centre for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark
| | - Deborah Davis
- University of Canberra and ACT Health, Bruce, Australia
| | - Ellen Aagaard Nohr
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
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Myo T, Hong SA, Thepthien BO, Hongkrailert N. Prevalence and Factors Associated with Postpartum Depression in Primary Healthcare Centres in Yangon, Myanmar. Malays J Med Sci 2021; 28:71-86. [PMID: 34512132 PMCID: PMC8407790 DOI: 10.21315/mjms2021.28.4.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 03/11/2021] [Indexed: 11/08/2022] Open
Abstract
Background Postpartum depression (PPD) can have serious consequences on both the mother and infant. Despite the higher prevalence, there are limited numbers of studies on PPD in low-and middle-income countries, like Myanmar. This study aimed to explore the prevalence and associated factors of PPD in primary healthcare settings in Myanmar. Methods This cross-sectional online study was conducted with 220 mothers under 6 months postpartum in April–May 2020 and who registered in public health centres in Kungyangone Township, Yangon, Myanmar. The postpartum depression was measured with the Edinburgh postpartum depression scale (EPDS, ≥ 13 scores). Independent variables included sociodemographic factors, obstetric and infant factors, psychosocial factors (social support and social media usage), health services utilisation and accessibility factors. Chi-square tests and multiple logistic regression were performed. Results Overall prevalence of depressive symptoms in 220 women under 6 months postpartum was 31.8% (95% confidence interval [CI]: 25.9, 37.3). In multiple logistic regression, unplanned pregnancy (adjusted odds ratio [AOR]: 2.946), less than four times antenatal care (ANC) visits (AOR: 2.518), travel time more than 1 h to reach health centres (AOR: 3.068) and birth interval more than 5 years (AOR: 4.594) were more likely to be associated with PPD, while preterm delivery (AOR: 0.091) was inversely associated. Conclusion This study showed the relatively high prevalence of PPD and the strong association with preterm delivery, pregnancy intention, breastfeeding status, birth interval as well as frequency of ANC received and travel time to health centre. It may suggest that maternal mental health services should be integrated with existing maternal and child health (MCH) services for early detection and prevention of depression symptoms with promotion of MCH services utilisation and improved accessibility among mothers in primary healthcare setting.
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Affiliation(s)
- Theigi Myo
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand
| | - Seo Ah Hong
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand
| | - Bang-On Thepthien
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand
| | - Nate Hongkrailert
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand
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6
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Postpartum Depression, Complications During Pregnancy, and Offspring Behavior Problems in Early Childhood. CHILD & YOUTH CARE FORUM 2021. [DOI: 10.1007/s10566-021-09630-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Blanc J, Rességuier N, Lorthe E, Goffinet F, Sentilhes L, Auquier P, Tosello B, d'Ercole C. Association between extremely preterm caesarean delivery and maternal depressive and anxious symptoms: a national population-based cohort study. BJOG 2020; 128:594-602. [PMID: 32931138 DOI: 10.1111/1471-0528.16499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate whether caesarean delivery before 26 weeks of gestation was associated with symptoms of depression and anxiety in mothers in comparison with deliveries between 26 and 34 weeks. DESIGN Prospective national population-based EPIPAGE-2 cohort study. SETTING 268 neonatology departments in France, March to December 2011. POPULATION Mothers who delivered between 22 and 34 weeks and whose self-reported symptoms of depression (Center for Epidemiologic Studies Depression Scale: CES-D) and anxiety (State-Trait Anxiety Inventory: STAI) were assessed at the moment of neonatal discharge. METHODS The association of caesarean delivery before 26 weeks with severe symptoms of depression (CES-D ≥16) and anxiety (STAI ≥45) was assessed by weighted and design-based log-linear regression model. MAIN OUTCOME MEASURES Severe symptoms of depression and anxiety in mothers of preterm infants. RESULTS Among the 2270 women completing CES-D and STAI questionnaires at the time of neonatal discharge, severe symptoms of depression occurred in 25 (65.8%) women having a caesarean before 26 weeks versus in 748 (50.6%) women having a caesarean after 26 weeks. Caesarean delivery before 26 weeks was associated with severe symptoms of depression compared with caesarean delivery after 26 weeks (adjusted relative risk [aRR] 1.42, 95% CI 1.12-1.81) adjusted to neonatal birthweight and severe neonatal morbidity among other factors. There was no evidence of an association between mode of delivery and symptoms of anxiety. CONCLUSIONS Mothers having a caesarean delivery before 26 weeks' gestation are at high risk of symptoms of depression and may benefit from specific preventive care. TWEETABLE ABSTRACT Mothers having caesarean delivery before 26 weeks' gestation are at high risk of symptoms of depression.
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Affiliation(s)
- J Blanc
- Department of Obstetrics and Gynaecology, APHM, Nord Hospital, Marseille, France.,EA3279, CEReSS, Health Service Research and Quality of Life Centre, Aix-Marseille University, Marseille, France
| | - N Rességuier
- EA3279, CEReSS, Health Service Research and Quality of Life Centre, Aix-Marseille University, Marseille, France
| | - E Lorthe
- INSERM, INRA, Epidemiology and Statistics Research Centre/CRESS, Université de Paris, Paris, France.,EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal
| | - F Goffinet
- INSERM, INRA, Epidemiology and Statistics Research Centre/CRESS, Université de Paris, Paris, France.,Maternité Port-Royal, AP-HP, AP-HP Centre-Université de Paris, Paris, France
| | - L Sentilhes
- Department of Obstetrics and Gynaecology, Bordeaux University Hospital, Bordeaux, France
| | - P Auquier
- EA3279, CEReSS, Health Service Research and Quality of Life Centre, Aix-Marseille University, Marseille, France
| | - B Tosello
- Department of Neonatology, Assistance Publique des Hôpitaux de Marseille, North Hospital, France.,CNRS, EFS, ADES, Aix-Marseille University, Marseille, France
| | - C d'Ercole
- Department of Obstetrics and Gynaecology, APHM, Nord Hospital, Marseille, France.,EA3279, CEReSS, Health Service Research and Quality of Life Centre, Aix-Marseille University, Marseille, France
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Ucar N, Pinar SE. The hospital stressors and depression, anxiety levels in pregnant women hospitalized due to preterm delivery: A follow-up study. Perspect Psychiatr Care 2020; 56:290-296. [PMID: 31347190 DOI: 10.1111/ppc.12426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/19/2019] [Accepted: 07/14/2019] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To determine the hospital stressors and depression, anxiety levels in pregnant women hospitalized due to preterm delivery. DESIGN AND METHODS This descriptive pretest-posttest study consisted of 147 pregnant women with preterm delivery. Follow-up was performed twice. Data were collected using the Personal Information Form, the Beck Depression Inventory, the State Anxiety Inventory (SAI)-Trait Anxiety Inventory, and the Antepartum Hospital Stressors Inventory (AHSI). FINDINGS A statistically significant difference was found between the average scores of the SAI during the first and second measurements. A statistically significant difference was found between the average scores of the first and second measurement of AHSI (P < .05). PRACTICE IMPLICATIONS Anxiety, depression, and hospital stressors negatively affect gestations during both hospitalization and discharge.
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Affiliation(s)
- Nefise Ucar
- Department of Midwifery, Keles Entegre District Hospital, Bursa, Turkey
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Griffiths J, Lever Taylor B, Morant N, Bick D, Howard LM, Seneviratne G, Johnson S. A qualitative comparison of experiences of specialist mother and baby units versus general psychiatric wards. BMC Psychiatry 2019; 19:401. [PMID: 31842836 PMCID: PMC6916441 DOI: 10.1186/s12888-019-2389-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mother and baby units (MBUs) are an inpatient mental health service where women experiencing acute severe postpartum psychiatric difficulties can be admitted with their babies. They are currently viewed as best practice in the UK and elsewhere. However, as service provision is fragmented, some women residing in areas without MBUs are admitted to acute general psychiatric wards without their infants. This study aimed to compare qualitatively experiences of these two service types from the perspectives of women and clinicians. METHODS Semi-structured interviews were conducted with fifteen women who received treatment for perinatal mental health problems on a general psychiatric ward and/or MBU in England. Two focus groups were also conducted, one with MBU staff (n = 11) and one with acute ward staff (n = 6). Data were analysed thematically. RESULTS Women generally preferred being co-admitted with their baby to an MBU over lone admission to a general psychiatric ward. Women and clinicians felt that MBUs provided more perinatally-focused, family-centred care, and were better-equipped to meet women's needs. General wards were reported by women and staff to lack the necessary facilities and expertise to support perinatal women adequately, while separation of mothers and babies was often experienced by women as traumatic and detrimental to recovery. However, some areas for improvement were also identified across both service types, particularly relating to difficulties transitioning home post-discharge, inadequate support for family members, staffing issues and access problems (with MBUs). CONCLUSIONS Findings suggest that specialist perinatal inpatient care is considered preferable to generic care in the perinatal period from both service user and staff perspectives. Increased collaboration between perinatal and non-perinatal services could help improve perinatal expertise on general psychiatric wards, while further expansion of perinatal services (e.g. to cater for women currently considered too high risk for MBUs and for those discharged from inpatient settings) could tackle other shortfalls in care.
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Affiliation(s)
- Jessica Griffiths
- 0000000121901201grid.83440.3bDivision of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Billie Lever Taylor
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Nicola Morant
- 0000000121901201grid.83440.3bDivision of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Debra Bick
- 0000 0000 8809 1613grid.7372.1Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill, Coventry, CV4 7AL UK
| | - Louise M. Howard
- 0000 0001 2322 6764grid.13097.3cSection of Women’s Mental Health, Institute of Psychiatry Psychology and Neuroscience, King’s College London, Crespigny Park, London, SE5 8AF UK
| | - Gertrude Seneviratne
- 0000 0001 2324 5535grid.415717.1South London and Maudsley NHS Foundation Trust Channi Kumar Mother and Baby Unit, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, BR3 3BX UK
| | - Sonia Johnson
- 0000000121901201grid.83440.3bDivision of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
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Mental health help-seeking patterns and perceived barriers for care among nulliparous pregnant women. Arch Womens Ment Health 2018; 21:757-764. [PMID: 29846799 DOI: 10.1007/s00737-018-0864-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/17/2018] [Indexed: 10/16/2022]
Abstract
This study examined the patterns of consultation with health providers for emotional symptoms and barriers preventing mental health help-seeking among pregnant women. A total of 652 nulliparous women in their third trimester completed an online questionnaire assessing depressed mood, adjustment in their couple relationship, demographics, help-seeking behaviors for emotional problems and barriers to help-seeking in the past year. The prevalence of having consulted with at least one health provider over the past year for emotional symptoms was 20.1% for the entire sample and 32.7% for the subgroup of women reporting elevated depressive symptoms in the third trimester. Women in the 30-39 age range were more likely to discuss their emotional symptoms with a health provider in the past year compared to younger women (OR = 1.6, CI = 1.0, 2.6, p = 0.041). Among women depressed in the third trimester, being White was independently associated with a greater likelihood of having consulted with a health provider about their emotional symptoms (OR = 2.9, CI = 1.4, 6.1, p = 0.005). Barriers to mental help-seeking included not having gotten around to it (46.1%), being too busy (26.1%), deciding not to seek care (24.3%), cost (22.6%) and not knowing where to go (19.1%). Women with more depressive symptoms in the third trimester endorsed more barriers to mental health service use (β = 0.25, 95% CI = 0.02, 0.12, p = 0.015). Innovative, evidence-based approaches are needed to more effectively promote mental health during the perinatal period and help women overcome the practical barriers identified to help-seeking.
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Riazanova OV, Alexandrovich YS, Ioscovich AM. The relationship between labor pain management, cortisol level and risk of postpartum depression development: a prospective nonrandomized observational monocentric trial. Rom J Anaesth Intensive Care 2018; 25:123-130. [PMID: 30393769 DOI: 10.21454/rjaic.7518.252.rzn] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Postpartum depression (PPD) is the main psychological status disorder and women suffering from postpartum depression often need long-term psychological and socio-economic rehabilitation. The study is dedicated to the evaluation of the role of labor pain management using epidural analgesia in natural delivery on stress level in labor and frequency of postnatal depression. Materials and methods 210 women were investigated and divided into two groups. In the first group for labor pain management in natural delivery, patient-controlled epidural analgesia was used (bolus - 10.0 - 0.08% ropivacaine hydrochloride, lockout - 30 min, limit - 120 ml/6 h) with a background of continuous-flow infusion of local anesthetic 0.08% ropivacaine hydrocluoride solution. Patients in the second group had no pain relief in delivery. The stress level was evaluated using blood plasma cortisol level in the early stages of labor, 6 hours and 3 days after delivery. The assessment of depression development was carried out step-by-step: Before the delivery, 6 hours after, 3 days and 6 weeks after the delivery. Results The baby blues frequency 6 hours after the delivery in the group where the pain relief was conducted was 29.91%, with cortisol level below and equal to 2310.91 nmol/l. In the group with no pain relief 6 hours after delivery, baby blues was found in 15.53% of puerperas (p < 0.05) and the cortisol level was 2673.82 nmol/l (p < 0.05). Six weeks after the birth, postpartum depression was diagnosed in 4.67% of women who received epidural analgesia during delivery, in comparison to 6.79% with no pain relief during delivery. However, the difference was not statistically significant (p < 0.05). Conclusions The use of epidural analgesia leads to a significant reduction of pain syndrome and stress response during natural delivery, increases the risk of baby blues in the early postnatal period, but slightly influences the frequency of postpartum depression.
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Affiliation(s)
- Oksana V Riazanova
- Department of Anesthesiology and Intensive Care, Saint-Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - Yurii S Alexandrovich
- Department of Anesthesiology and Intensive Care, Saint-Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - Alexander M Ioscovich
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
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Barkmann C, Helle N, Bindt C. Is very low infant birth weight a predictor for a five-year course of depression in parents? A latent growth curve model. J Affect Disord 2018; 229:415-420. [PMID: 29331702 DOI: 10.1016/j.jad.2017.12.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 11/20/2017] [Accepted: 12/09/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND A very low birth weight (VLBW) is considered as a significant risk factor for early-onset developmental problems in infants, but is also discussed as a potential risk factor for the development of depressive symptoms in affected parents. METHODS In this study, the 5-year courses of maternal and paternal depression with VLBW and term born infants (n = 250 families) are modeled and predicted by factors existing at the time of birth. RESULTS The dyadic trajectories of depression could be best described by five classes (I no depression, II minor maternal depression, III increasing dyadic depression, IV significant maternal depression, V highly depressed mothers). VLBW was a significant predictor for the course of parental depression - even under control of preexisting psychiatric disorders and other confounders. Interaction effects and a dose-response relationship were not existent. LIMITATIONS Class IV and V had to be merged for the prediction analysis, a missing bias could not be ruled out, and families with a low birth weight (between 2500 and 1500g) were not included. CONCLUSIONS The results are well in line with what is known from studies so far, suggesting that maternal and paternal trajectories of depression show distinctable patterns which are associated with a VLBW. An early screening of mothers and fathers of a VLBW infant seems reasonable to prevent the development of a depression in parents and further difficulties for the child.
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Affiliation(s)
- Claus Barkmann
- Department for Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Germany.
| | - Nadine Helle
- Department for Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Germany
| | - Carola Bindt
- Department for Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Germany
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13
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Garcia ER, Yim IS. A systematic review of concepts related to women's empowerment in the perinatal period and their associations with perinatal depressive symptoms and premature birth. BMC Pregnancy Childbirth 2017; 17:347. [PMID: 29143635 PMCID: PMC5688402 DOI: 10.1186/s12884-017-1495-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The perinatal period, which we here define as pregnancy and the first year postpartum, is a time in women’s lives that involves significant physiological and psychosocial change and adjustment, including changes in their social status and decision-making power. Supporting women’s empowerment at this particular time in their lives may be an attractive opportunity to create benefits for maternal and infant health outcomes such as reductions in perinatal depressive symptoms and premature birth rates. Thus, we here systematically review and critically discuss the literature that investigates the effects of empowerment, empowerment-related concepts and empowerment interventions on reductions in perinatal depressive symptoms, preterm birth (PTB), and low birthweight (LBW). Methods For this systematic review, we conducted a literature search in PsychInfo, PubMed, and CINAHL without setting limits for date of publication, language, study design, or maternal age. The search resulted in 27 articles reporting on 25 independent studies including a total of 17,795 women. Results The majority of studies found that, for the most part, measures of empowerment and interventions supporting empowerment are associated with reduced perinatal depressive symptoms and PTB/LBW rates. However, findings are equivocal and a small portion of studies found no significant association between empowerment-related concepts and perinatal depressive symptoms and PTB or LBW. Conclusion This small body of work suggests, for the most part, that empowerment-related concepts may be protective for perinatal depressive symptoms and PTB/LBW. We recommend that future theory-driven and integrative work should include an assessment of different facets of empowerment, obtain direct measures of empowerment, and address the relevance of important confounders, including for example, ethnicity and socioeconomic status. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1495-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Esmeralda R Garcia
- Department of Psychology and Social Behavior, University of California, 4562 Social and Behavioral Sciences Gateway, Irvine, CA, 92697-7085, USA
| | - Ilona S Yim
- Department of Psychology and Social Behavior, University of California, 4562 Social and Behavioral Sciences Gateway, Irvine, CA, 92697-7085, USA.
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14
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Hernández-Díaz S, McElrath TF, Pennell PB, Hauser WA, Yerby M, Holmes LB. Fetal growth and premature delivery in pregnant women on antiepileptic drugs. Ann Neurol 2017; 82:457-465. [DOI: 10.1002/ana.25031] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/23/2017] [Accepted: 08/24/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Sonia Hernández-Díaz
- Department of Epidemiology; Harvard T. H. Chan School of Public Health; Boston MA
| | - Thomas F. McElrath
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital; Boston MA
| | - Page B. Pennell
- Divisions of Epilepsy and Women's Health, Department of Neurology, Brigham and Women's Hospital; Boston MA
| | - W. Allen Hauser
- College of Physicians and Surgeons and Mailman School of Public Health; Columbia University; New York NY
| | - Mark Yerby
- Oregon Health and Science University; Portland OR
| | - Lewis B. Holmes
- North American Antiepileptic Drug Pregnancy Registry, MassGeneral Hospital for Children; Boston MA
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15
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Stevens NR, Tirone V, Lillis TA, Holmgreen L, Chen-McCracken A, Hobfoll SE. Posttraumatic stress and depression may undermine abuse survivors' self-efficacy in the obstetric care setting. J Psychosom Obstet Gynaecol 2017; 38:103-110. [PMID: 27960615 DOI: 10.1080/0167482x.2016.1266480] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Posttraumatic stress symptoms (PTS) are associated with increased risk of obstetric complications among pregnant survivors of trauma, abuse and interpersonal violence, but little is known about how PTS affects women's actual experiences of obstetric care. This study investigated the rate at which abuse history was detected by obstetricians, whether abuse survivors experienced more invasive exams than is typically indicated for routine obstetric care, and whether psychological distress was associated with abuse survivors' sense of self-efficacy when communicating their obstetric care needs. METHODS Forty-one pregnant abuse survivors completed questionnaires about abuse history, current psychological distress and self-efficacy for communicating obstetric care needs and preferences. Electronic medical records (EMRs) were reviewed to examine frequency of invasive prenatal obstetric procedures (e.g. removal of clothing for external genital examination, pelvic exams and procedures) and to examine the detection rate of abuse histories during the initial obstetric visit. RESULTS The majority of participants (83%) reported at least one past incident of violent physical or sexual assault. Obstetricians detected abuse histories in less than one quarter of cases. Nearly half of participants (46%) received invasive exams for non-routine reasons. PTS and depression symptoms were associated with lower self-efficacy in communicating obstetric care preferences. DISCUSSION Women most at risk for experiencing distress during their obstetric visits and/or undergoing potentially distressing procedures may also be the least likely to communicate their distress to obstetricians. Results are discussed with implications for improving screening for abuse screening and distress symptoms as well as need for trauma-sensitive obstetric practices.
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Affiliation(s)
- Natalie R Stevens
- a Department of Behavioral Sciences , Rush University Medical Center , Chicago , IL , USA
| | - Vanessa Tirone
- a Department of Behavioral Sciences , Rush University Medical Center , Chicago , IL , USA
| | - Teresa A Lillis
- a Department of Behavioral Sciences , Rush University Medical Center , Chicago , IL , USA
| | - Lucie Holmgreen
- a Department of Behavioral Sciences , Rush University Medical Center , Chicago , IL , USA
| | - Allison Chen-McCracken
- b Department of Obstetrics & Gynecology , Rush University Medical Center , Chicago , IL , USA
| | - Stevan E Hobfoll
- a Department of Behavioral Sciences , Rush University Medical Center , Chicago , IL , USA
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16
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Jølving LR, Nielsen J, Kesmodel US, Nielsen RG, Beck-Nielsen SS, Nørgård BM. Prevalence of maternal chronic diseases during pregnancy - a nationwide population based study from 1989 to 2013. Acta Obstet Gynecol Scand 2017; 95:1295-1304. [PMID: 27560844 DOI: 10.1111/aogs.13007] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 08/22/2016] [Indexed: 12/13/2022]
Abstract
INTRODUCTION There is substantial evidence of a negative impact of maternal chronic disease during pregnancy on reproductive outcomes. Knowledge of the prevalence of chronic diseases during pregnancy is limited, but essential for a focused preventive effort regarding optimal disease control during pregnancy. We aimed to analyze the prevalence of chronic diseases during pregnancy. MATERIAL AND METHODS This register-based cohort study included all women giving birth in Denmark between 1989 and 2013 based on data from Danish health registers. Maternal chronic diseases included 23 disease categories of both physical and mental health conditions recorded within a period of 10 years before childbirth. RESULTS We included 1 362 200 childbirths during the study period. The overall prevalence of maternal chronic disease increased from 3.71% in 1989 to 15.76% in 2013. The most frequently registered chronic diseases were chronic lung diseases/asthma (1.73%), thyroid disorders (1.50%) and anxiety and personality disorders (1.33%). Taking increasing maternal age at birth into account, the relative risk for women to have a chronic disease from 2009 to 2013 was 4.14 (95% CI 4.05-4.22), compared with mothers giving birth from 1989 to 1993. CONCLUSIONS We found an increasing prevalence of maternal chronic disease during pregnancy and more than a four-fold increased risk of maternal chronic disease during pregnancy for childbirths in the period 2009 through 2013, compared with 1989 through 1993. The main limitation of our study is related to a potentially greater awareness and hence more careful registration of maternal chronic disease over time and thereby an increased tendency to register diseases.
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Affiliation(s)
- Line Riis Jølving
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark. .,Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Jan Nielsen
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark.,Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ulrik Schiøler Kesmodel
- Department of Obstetrics and Gynecology, Herlev University Hospital, Copenhagen, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Gaardskaer Nielsen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Research Unit of Pediatrics, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Signe Sparre Beck-Nielsen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Research Unit of Pediatrics, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bente Mertz Nørgård
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark.,Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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17
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Horton LG, Folger SG, Berry-Bibee E, Jatlaoui TC, Tepper NK, Curtis KM. Research gaps from evidence-based contraception guidance: the US Medical Eligibility Criteria for Contraceptive Use, 2016, and the US Selected Practice Recommendations for Contraceptive Use, 2016. Contraception 2016; 94:582-589. [DOI: 10.1016/j.contraception.2016.07.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 07/14/2016] [Accepted: 07/18/2016] [Indexed: 11/27/2022]
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18
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Heldreth CM, Guardino CM, Wong LH, Schetter CD, Shapiro JR, Schafer P, Shalowitz M, Lanzi RG, Thorp J, Raju T. Childhood Racism Experiences and Postpartum Depressive Symptoms in African American Mothers. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2016. [DOI: 10.1521/jscp.2016.35.10.840] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Berry-Bibee EN, Kim MJ, Simmons KB, Tepper NK, Riley HE, Pagano HP, Curtis KM. Drug interactions between hormonal contraceptives and psychotropic drugs: a systematic review. Contraception 2016; 94:650-667. [DOI: 10.1016/j.contraception.2016.07.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
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20
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Loftus CT, Stewart OT, Hensley MD, Enquobahrie DA, Hawes SE. A Longitudinal Study of Changes in Prenatal Care Utilization Between First and Second Births and Low Birth Weight. Matern Child Health J 2016; 19:2627-35. [PMID: 26138322 DOI: 10.1007/s10995-015-1783-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Because previous analyses of prenatal care (PNC) utilization and risk of low birth weight (LBW) may have been influenced by selection bias, we conducted a study using longitudinal data of women with repeat pregnancies. METHODS We analyzed Washington State birth certificates of first and second live births (2003-2012). We estimated relative risk (RR) of LBW at second birth associated with Kotelchuck Index PNC level among women stratified by level of PNC in their first birth (n = 67,571). RESULTS Among women with inadequate PNC prior to their first birth (n = 10,355), women with intermediate or adequate PNC before their second birth (n = 7464) had a reduced risk of LBW (adjusted RR 0.61, 95% CI: 0.48, 0.78) compared to those whose PNC level remained inadequate. Likewise, among women with intermediate or adequate PNC prior to their first birth (n = 57,216), those with inadequate PNC before the second birth (n = 7095) had higher risk of LBW (adjusted RR 1.59, 95% CI: 1.36, 1.85) compared to those who remained at intermediate or adequate PNC. CONCLUSIONS Our findings support the hypothesis that PNC decreases LBW risk at second birth, independent of factors related to the utilization of PNC at first birth.
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Affiliation(s)
- Christine T Loftus
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA, 98195, USA
| | - Orion T Stewart
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA, 98195, USA.
| | - Mark D Hensley
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA, 98195, USA
| | - Daniel A Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA, 98195, USA
| | - Stephen E Hawes
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA, 98195, USA
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21
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Dollberg DG, Rozenfeld T, Kupfermincz M. Early Parental Adaptation, Prenatal Distress, and High-Risk Pregnancy. J Pediatr Psychol 2016; 41:915-29. [PMID: 27122389 DOI: 10.1093/jpepsy/jsw028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 03/10/2016] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES To examine the examined the effects of high risk pregnancy and prenatal distress on parental postnatal adaptation. METHODS A sample of 111 expecting parents, consisting of 32 high risk pregnancy (HRP) mothers and 21 spouses and 36 matched low risk pregnancy (LRP) mothers and 22 spouses completed reports of depression symptoms (BDI) and pregnancy related concerns prenatally. At three months postpartum, parent-infant direct observations and reports of parenting alliance (PAI), stress (PSI-SF), satisfaction and efficacy (PSOC) were gathered. Data was analyzed with GLM multivariate analyses and the actor-partner interdependence model. RESULTS Parents' prenatal BDI predicted postnatal parental stress. BDI and concerns predicted postnatal satisfaction, but only for mothers. Mother's concerns predicted low maternal and high paternal parenting alliance. Partner effect was found so that high concerns predicted high reports of parenting alliance by spouse. Mean-group differences were found between HRP and LRP during parent-infant observations, so that HRP parents displayed lower sensitivity and reciprocity. CONCLUSIONS Prenatal distress, and to some degree high risk pregnancy, are risk factors that may interfere with the early formation of parent-infant relationship. Clinical implications of these findings are presented.
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Affiliation(s)
- Daphna G Dollberg
- School of Behavioral Sciences, Academic College of Tel Aviv-Yaffo and
| | - Tamir Rozenfeld
- School of Behavioral Sciences, Academic College of Tel Aviv-Yaffo and
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22
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Abdollahi F, Agajani-Delavar M, Zarghami M, Lye MS. Postpartum Mental Health in First-Time Mothers: A Cohort Study. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2016; 10:e426. [PMID: 31168307 PMCID: PMC6549244 DOI: 10.17795/ijpbs-426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 11/30/2015] [Accepted: 01/13/2016] [Indexed: 11/25/2022]
Abstract
Background Post-partum depression (PPD) can produce adverse symptoms that make motherhood one of the most tumultuous events in a female’s life. First-time mothers who have problems adapting themselves to the mother’s role are more vulnerable to PPD. Objectives The current study aimed to explore the extent of social support and parental self-efficacy on PPD, this study was conducted among the first-time pregnant women. Patients and Methods A prospective cohort study assessed the depressive symptoms and related factors among 838 first-time not depressed pregnant women from third trimester of pregnancy to 12 weeks postpartum who attended primary health centers (Jan to July 2009). The study employed Edinburgh postnatal depression scale, social support appraisals scale, network orientation scale, marital inventory, parental expectation survey and socio-demographic questionnaires. Logistic regression was used for data analysis. Results The incidence of depression was 10.7% at three months post-partum. The adjusted odds ratio showed the PPD was associated with perceived social isolation (OR = 1.06; 95% CI = 1.01 - 1.12), lack of marital satisfaction (OR = 0.91; 95% CI = 0.86 - 0.97) and low parental self-efficacy (OR = 0.74; 95% CI = 0.65 - 0.85). Conclusions A high incidence of PPD was identified among the first-time mothers which makes PPD one of the major health problems in females. The important effects of perceived social isolation, maternal parental self-efficacy, and marital satisfaction on reducing the risk of PPD should be considered.
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Affiliation(s)
- Fatemeh Abdollahi
- Public Health Department, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Mazandaran, IR Iran
| | - Mouloud Agajani-Delavar
- Department of Midwifery, Faculty of Nursing, Fatemezahra Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol, Mazandaran, IR Iran
| | - Mehran Zarghami
- Department of Psychiatry, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, IR Iran.,Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Mazandaran, IR Iran
| | - Munn-Sann Lye
- Department of Community Health, Faculty of Medicine and Health Sciences, University of Putra Malaysia, Serdang, Malaysia
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Enatescu VR, Bernad E, Gluhovschi A, Papava I, Romosan R, Palicsak A, Munteanu R, Craina M, Enatescu I. Perinatal characteristics and mother's personality profile associated with increased likelihood of postpartum depression occurrence in a Romanian outpatient sample. J Ment Health 2016; 26:212-219. [PMID: 26925764 DOI: 10.3109/09638237.2016.1149802] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Postpartum depression represents an increasingly recognized psychiatric condition in new mothers, and even more so in recent years as its detection has improved. AIMS This study aimed to reveal those maternal and perinatal parameters that are significantly associated with increased likelihood of postpartum depression in delivering mothers from our region. METHODS A cross-sectional survey was conducted in 163 women between 6 and 8 weeks after delivery. Postnatal depression was assessed by the Edinburgh Postnatal Depression Scale (EPDS) using a cut-off of >12. RESULTS Postnatal depression was detected in 39 (23.93%) new mothers. The preterm delivery [odds ratio (OR) 7.233; 95% confidence interval (CI) 1.631-32.078; p = 0.009], presence of complications during pregnancy (OR 4.579; 95% CI 1.314-15.953; p = 0.017) and being primiparous (OR 3.388; 95% CI 1.430-8.025; p = 0.006) have been associated with an increased likelihood of subsequent postpartum depression. Anxiety traits of personality were the most represented in depressive mothers. CONCLUSIONS Postpartum depression is a frequent psychiatric condition in new mothers from our region. These results outline the critical role of mother's profile of personality which in a particular context of perinatal events could result in an increased likelihood of postpartum depression requiring a multidisciplinary approach.
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Affiliation(s)
| | - Elena Bernad
- b Department of Obstetrics, Gynecology and Neonatology , Victor Babes University of Medicine and Pharmacy , Timisoara , Romania , and
| | - Adrian Gluhovschi
- b Department of Obstetrics, Gynecology and Neonatology , Victor Babes University of Medicine and Pharmacy , Timisoara , Romania , and
| | | | | | | | - Rosana Munteanu
- c Eduard Pamfil Psychiatric Clinic, Timisoara County Emergency Clinical Hospital , Timisoara , Romania
| | - Marius Craina
- b Department of Obstetrics, Gynecology and Neonatology , Victor Babes University of Medicine and Pharmacy , Timisoara , Romania , and
| | - Ileana Enatescu
- b Department of Obstetrics, Gynecology and Neonatology , Victor Babes University of Medicine and Pharmacy , Timisoara , Romania , and
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Da Costa D, Zelkowitz P, Bailey K, Cruz R, Bernard JC, Dasgupta K, Lowensteyn I, Khalifé S. Results of a Needs Assessment to Guide the Development of a Website to Enhance Emotional Wellness and Healthy Behaviors During Pregnancy. J Perinat Educ 2016; 24:213-24. [PMID: 26834443 DOI: 10.1891/1058-1243.24.4.213] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In preparation for developing a website to enhance emotional wellness and healthy lifestyle during the perinatal period, this study examined women's informational needs and barriers. Seventy-four women who were pregnant or had given birth completed an online survey inquiring about information needs and preferred sources related to psychosocial aspects and lifestyle behaviors. Information related to healthy diet choices and weight management, followed by exercise, was rated highly as a need. Information related to depression, stress, and anxiety was also rated as important. Health-care providers and the Internet were found to be preferred sources of information. Evidence-based websites can serve as a powerful low-cost educational resource to support and reinforce the health promotion advice received from their health-care providers.
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Perinatal distress in women in low- and middle-income countries: allostatic load as a framework to examine the effect of perinatal distress on preterm birth and infant health. Matern Child Health J 2015; 18:2393-407. [PMID: 24748241 PMCID: PMC4220111 DOI: 10.1007/s10995-014-1479-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In low- and middle-income countries (LMIC), determinants of women’s and children’s health are complex and differential vulnerability may exist to risk factors of perinatal distress and preterm birth. We examined the contribution of maternal perinatal distress on preterm birth and infant health in terms of infant survival and mother–infant interaction. A critical narrative and interpretive literature review was conducted. Peer-reviewed electronic databases (MEDLINE, Embase, Global Health, CINHAL), grey literature, and reference lists were searched, followed by a consultation exercise. The literature was predominantly from high-income countries. We identify determinants of perinatal distress and explicate changes in the hypothalamic–pituitary–adrenal axis, sympathetic, immune and cardiovascular systems, and behavioral responses resulting in pathophysiological effects. We suggest cultural–neutral composite measures of allostatic mediators (i.e., several biomarkers) of maternal perinatal distress as objective indicators of dysregulation in body systems in pregnant women in LMIC. Understanding causal links of maternal perinatal distress to preterm birth in women in LMIC should be a priority. The roles of allostasis and allostatic load are considered within the context of the health of pregnant women and fetuses/newborns in LMIC with emphasis on identifying objective indicators of the level of perinatal distress and protective factors or processes contributing to resilience while facing toxic stress. We propose a prospective study design with multiple measures across pregnancy and postpartum requiring complex statistical modeling. Building research capacity through partnering researchers in high-income countries and LMIC and reflecting on unique ethical challenges will be important to generating new knowledge in LMIC.
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Helle N, Barkmann C, Bartz-Seel J, Diehl T, Ehrhardt S, Hendel A, Nestoriuc Y, Schulte-Markwort M, von der Wense A, Bindt C. Very low birth-weight as a risk factor for postpartum depression four to six weeks postbirth in mothers and fathers: Cross-sectional results from a controlled multicentre cohort study. J Affect Disord 2015; 180:154-61. [PMID: 25911131 DOI: 10.1016/j.jad.2015.04.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 04/01/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Preterm birth and survival rates of very low birth-weight (VLBW: <1.500g) infants have increased. Although new parents are frequently affected by depressive symptoms, little is known about prevalence, risk, and predictors of parental postpartum depression (PPD) following VLBW birth. Furthermore, most studies assessing PPD in parents of preterm children relied on self-report only. METHODS As part of the HaFEn cohort-study, data from the index groups of parents with VLBW infants and the control group of parents with term infants were cross-sectionally analysed. Families were recruited at the three largest centres of perinatal medical care in Hamburg, Germany. PPD was evaluated one month postpartum using standardized questionnaires and clinical interviews. Socioeconomic status, social support, risks during pregnancy, and psychiatric lifetime diagnoses were also assessed. A multiple random coefficient model was used to examine predictors of PPD in both parents simultaneously. RESULTS 230 mothers and 173 fathers were included. Depending on the measure, the risk of being postnatally depressed was 4 to 18 times higher in mothers and 3 to 9 times higher in fathers from the index group. The most relevant risk factor for PPD was the birth of a VLBW infant, followed by female sex, lifetime psychiatric disorder, and low social support. LIMITATIONS Results presented here, are based on cross sectional data. Therefore no temporal relationships can be established. CONCLUSIONS Our findings highlight the importance of early screening for PPD in both parents of VLBW infants. Factors contributing to developing depression should also be considered in neonatal care.
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Affiliation(s)
- Nadine Helle
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Germany.
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Germany
| | - Jutta Bartz-Seel
- Department of Neonatology and Paediatric Critical Care, Neonatal Intensive Care Unit, Altona Children׳s Hospital, Hamburg, Germany
| | - Thilo Diehl
- Department of Paediatrics, Neonatal Intensive Care Unit, University Medical Center Hamburg-Eppendorf, Germany
| | - Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Astrid Hendel
- Department of Neonatology, Neonatal Intensive Care Unit, Asklepios Medical Center Barmbek, Hamburg, Germany
| | - Yvonne Nestoriuc
- Institute of Psychology, Clinical Psychology and Psychotherapy, Hamburg University, Hamburg, Germany
| | - Michael Schulte-Markwort
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Germany
| | - Axel von der Wense
- Department of Neonatology and Paediatric Critical Care, Neonatal Intensive Care Unit, Altona Children׳s Hospital, Hamburg, Germany
| | - Carola Bindt
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Germany
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Associations of anxiety disorders, depressive disorders and body weight with hypertension during pregnancy. Arch Womens Ment Health 2015; 18:473-83. [PMID: 25422149 DOI: 10.1007/s00737-014-0474-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 10/18/2014] [Indexed: 12/29/2022]
Abstract
The purpose of this study was to prospectively examine the relationships between maternal DSM-IV-TR anxiety disorders, depressive disorders, and body mass index (BMI) with arterial hypertension and blood pressure during pregnancy. In the Maternal Anxiety in Relation to Infant Development (MARI) study, N = 306 women were enrolled in early pregnancy and repeatedly assessed during peripartum period. DSM-IV-TR anxiety and depressive disorders prior to pregnancy, lifetime anxiety/depression liability, and BMI during early pregnancy were assessed with the Composite International Diagnostic Interview for Women (CIDI-V). Based on their prepregnancy status, all participants were assigned to one of the following initial diagnostic groups: no anxiety nor depressive disorder (no AD), pure depressive disorder (pure D), pure anxiety disorder (pure A), and comorbid anxiety and depressive disorder (comorbid AD). Blood pressure measurements were derived from medical records. Arterial hypertension during pregnancy was defined by at least two blood pressure values ≥140 mmHg systolic and/or ≥90 mmHg diastolic. N = 283 women with at least four documented blood pressure measurements during pregnancy were included in the analyses. In this sample, N = 47 women (16.6 %) were identified with arterial hypertension during pregnancy. Women with comorbid AD (reference group: no AD) had a significantly higher blood pressure after adjustment for age, parity, smoking, occupation, household income, and education (systolic: linear regression coefficient [β] = 3.0, 95 % confidence interval [CI] = 0.2-5.7; diastolic, β = 2.3, 95 % CI = 0.1-4.4). Anxiety liability was associated with an increased risk of hypertension (odds ratio [OR] = 1.1, 95 % CI = 1.0-1.3) and a higher systolic blood pressure (β = 0.4, 95 % CI = 0.0-0.7). The adjusted interaction model revealed a significant interaction between the diagnostic group pure A and BMI for hypertension (ORIT = 1.5, 95 % CI = 1.1-2.1). Especially, women with a lifetime history of comorbid anxiety and depression and obese pregnant women with a lifetime history of pure anxiety disorder should be informed about their heightened risk of hypertension, monitored with regular blood pressure measurements, and provided with strategies for prevention and early intervention such as changes in diet and physical activity.
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Pinzón-Rondón ÁM, Gutiérrez-Pinzon V, Madriñan-Navia H, Amin J, Aguilera-Otalvaro P, Hoyos-Martínez A. Low birth weight and prenatal care in Colombia: a cross-sectional study. BMC Pregnancy Childbirth 2015; 15:118. [PMID: 25989797 PMCID: PMC4491421 DOI: 10.1186/s12884-015-0541-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 04/24/2015] [Indexed: 12/13/2022] Open
Abstract
Background Low birth weight (LBW) is one of the most important factors affecting child morbidity and mortality worldwide; approximately one third of neonatal deaths are attributable to it. Most research and public health policy on LBW arise from developed nations, despite that most cases (96.5%) take place in developing countries. The specific features of prenatal care that prevent LBW in developing countries are unclear. This study aims to identify the characteristics of prenatal care associated with LBW in a developing country as Colombia. Methods Observational cross-sectional study using data from the Colombian Demographic and Health Survey 2010. A total of 10,692 children were included. Descriptive statistics were calculated, followed by bivariate regressions of LBW with all other study variables. Finally, stepwise logistic binomial regression analyses were done. Results A LBW prevalence of 8.7% was found. Quality of prenatal care (95%CI: 0.33, 0.92; OR = 0.55), number of prenatal visits (95%CI: 0.92, 0.93; OR = 0.92), and first prenatal visits during pregnancy (95%CI: 1.02, 1.07; OR = 1.08) were associated with LBW even after controlling for all the studied variables. The health care provider conducting prenatal checkup, and insurance coverage, were not associated with LBW. Conclusion This research provides information on the characteristics of prenatal care (quality, number of visits, and gestational age at first prenatal visit) which may strengthen LBW prevention in Colombia and possibly in countries with similar socioeconomic characteristics.
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Affiliation(s)
| | | | | | - Jennifer Amin
- Escuela de medicina y ciencias de la salud, Universidad del Rosario, Bogota, Colombia.
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Martinson ML, Tienda M. Birthing, Nativity, and Maternal Depression: Australia and the United States. INTERNATIONAL MIGRATION REVIEW 2015; 50:793-824. [PMID: 27917013 PMCID: PMC5130151 DOI: 10.1111/imre.12173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study analyzes two birth cohort surveys, the Longitudinal Study of Australian Children (n=3944) and Early Childhood Longitudinal Study (n=7700), to examine variation in maternal depression by nativity, duration of residence, age at migration, and English proficiency in Australia and the United States. Both countries have long immigrant traditions and a common language. The results demonstrate that US immigrant mothers are significantly less depressed than native-born mothers, but maternal depression does not differ by nativity in Australia. Moreover, the association between duration of residence and maternal depression is not linear: recent arrivals and long-term residents exhibit the highest depression levels. Lack of English proficiency exacerbates maternal depression in Australia, but protects against depression in the United States. Differences in immigration regimes and welfare systems likely contribute to the differing salience of nativity for maternal depression.
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Affiliation(s)
| | - Marta Tienda
- Office of Population Research, Princeton University
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Weobong B, ten Asbroek AHA, Soremekun S, Manu AA, Owusu-Agyei S, Prince M, Kirkwood BR. Association of antenatal depression with adverse consequences for the mother and newborn in rural Ghana: findings from the DON population-based cohort study. PLoS One 2014; 9:e116333. [PMID: 25549334 PMCID: PMC4280205 DOI: 10.1371/journal.pone.0116333] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 12/05/2014] [Indexed: 12/31/2022] Open
Abstract
Background Whilst there is compelling evidence of an almost 2-fold increased risk of still births, and suggestive evidence of increased mortality among offspring of mothers with psychotic disorders, only three studies have addressed the role of antenatal depression (AND) on survival of the baby. We examined these associations in a large cohort of pregnant women in Ghana. Methods A Cohort study nested within 4-weekly surveillance of all women of reproductive age to identify pregnancies and collect data on births and deaths in the Kintampo Health Research Centre study area of Ghana. Women were screened for AND using the Patient Health Questionnaire (PHQ-9) to ascertain DSM-IV major or minor depression. Outcomes were adverse birth outcomes, maternal/infant morbidity, and uptake of key newborn care practices, examined using logistic regression; effect sizes reported as relative risks with 95% confidence intervals. Results 20679 (89.6%) pregnant women completed the PHQ-9. The prevalence of AND was 9.9% (n = 2032) (95% confidence interval 9.4%–10.2%). AND was associated with: prolonged labour (RR 1.25, 95% CI 1.02–1.53); peripartum complications (RR 1.11, 95% CI 1.07–1.15);postpartum complications (RR 1.27, 96% CI 1.21–1.34); non-vaginal delivery (RR 1.19, 95% CI 1.02–1.40); newborn illness (RR 1.52, 95% CI 1.16–1.99); and bed net use during pregnancy (RR 0.93, 95% CI 0.89–0.98), but not neonatal deaths, still births, low birth weight, immediate breast feeding initiation, or exclusive breastfeeding. AND was marginally associated with preterm births (RR 1.32, 95% CI 0.98–1.76). Conclusion This paper has contributed important evidence on the role of antenatal depression as a potential contributor to maternal and infant morbidity. Non-pharmacological treatments anchored on primary care delivery structures are recommended as an immediate step. We further recommend that trials are designed to assess if treating antenatal depression in conjunction with improving the quality of obstetric care results in improved maternal and newborn outcomes.
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Affiliation(s)
- Benedict Weobong
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | | | - Seyi Soremekun
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alexander A. Manu
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin Prince
- Health Services and Population Research Department, Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Betty R. Kirkwood
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Lassi ZS, Imam AM, Dean SV, Bhutta ZA. Preconception care: screening and management of chronic disease and promoting psychological health. Reprod Health 2014; 11 Suppl 3:S5. [PMID: 25415675 PMCID: PMC4196564 DOI: 10.1186/1742-4755-11-s3-s5] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION A large proportion of women around the world suffer from chronic diseases including mental health diseases. In the United States alone, over 12% of women of reproductive age suffer from a chronic medical condition, especially diabetes and hypertension. Chronic diseases significantly increase the odds for poor maternal and newborn outcomes in pregnant women. METHODS A systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for preventing and managing chronic diseases and promoting psychological health on maternal, newborn and child health outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture. RESULTS Maternal prepregnancy diabetic care is a significant intervention that reduces the occurrence of congenital malformations by 70% (95% Confidence Interval (CI): 59-78%) and perinatal mortality by 69% (95% CI: 47-81%). Furthermore, preconception management of epilepsy and phenylketonuria are essential and can optimize maternal, fetal and neonatal outcomes if given before conception. Ideally changes in antiepileptic drug therapy should be made at least 6 months before planned conception. Interventions specifically targeting women of reproductive age suffering from a psychiatric condition show that group-counseling and interventions leading to empowerment of women have reported non-significant reduction in depression (economic skill building: Mean Difference (MD) -7.53; 95% CI: -17.24, 2.18; counseling: MD-2.92; 95% CI: -13.17, 7.33). CONCLUSION While prevention and management of the chronic diseases like diabetes and hypertension, through counseling, and other dietary and pharmacological intervention, is important, delivering solutions to prevent and respond to women's psychological health problems are urgently needed to combat this leading cause of morbidity.
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Affiliation(s)
- Zohra S Lassi
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Ayesha M Imam
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Sohni V Dean
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
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Pooler J, Perry DF, Ghandour RM. Prevalence and risk factors for postpartum depressive symptoms among women enrolled in WIC. Matern Child Health J 2014; 17:1969-80. [PMID: 23329168 DOI: 10.1007/s10995-013-1224-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The objectives of this study were to determine the prevalence and correlates of postpartum depressive symptoms (PDS) among women with a recent live birth and specifically among women participating in and eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Pregnancy Risk Assessment and Monitoring System data from 22 states in 2006-2008 (n = 75,234) were used to estimate the prevalence of PDS using a two-question screener. Associations between PDS and respondent demographics, risk factors and behaviors, and WIC program eligibility and participation were assessed using logistic regression. Overall prevalence of PDS was 13.8 %:19.8 % among WIC participants, 16.3 % among non-participants eligible for WIC, and 6.8 % of women not eligible for the program. PDS prevalence was higher among younger, less educated, and poorer women, as well as those engaging in risky behaviors during pregnancy (smoking and binge drinking), and those with an unintended pregnancy and who experienced intimate partner violence during pregnancy. Controlling for these factors, the odds of PDS were no different between WIC participants and women eligible but not participating in the program (aOR 1.08, 95 % CI 0.97-1.22), but WIC enrollees were significantly more likely than ineligible women to report PDS (aOR 1.65, 95 % CI 1.39-1.95). WIC serves more than 1 million pregnant women each year, one-fifth of whom may experience PDS. WIC has a unique opportunity to screen and provide referrals to new mothers receiving postpartum WIC benefits.
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Affiliation(s)
- Jennifer Pooler
- Altarum Institute, 4 Milk Street, Third Floor, Portland, ME, 04101-4164, USA,
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Henriksen L, Schei B, Vangen S, Lukasse M. Sexual violence and mode of delivery: a population-based cohort study. BJOG 2014; 121:1237-44. [DOI: 10.1111/1471-0528.12923] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2014] [Indexed: 12/01/2022]
Affiliation(s)
- L Henriksen
- Section of Obstetrics; Department for Women's and Children's Health; Oslo University Hospital; Oslo Norway
| | - B Schei
- Department of Public Health and General Practice; Faculty of Medicine; The Norwegian University of Science and Technology; Trondheim Norway
- Department of Obstetrics and Gynaecology; St Olavs Hospital; Trondheim University Hospital; Trondheim Norway
| | - S Vangen
- National Resource Centre for Women's Health; Department for Women's and Children's Health; Oslo University Hospital; Oslo Norway
| | - M Lukasse
- Department of Public Health and General Practice; Faculty of Medicine; The Norwegian University of Science and Technology; Trondheim Norway
- Department of Health; Nutrition and Management; Faculty of Health Sciences; Oslo and Akershus University College of Applied Sciences; Oslo Norway
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Schminkey DL, Groer M. Imitating a stress response: a new hypothesis about the innate immune system's role in pregnancy. Med Hypotheses 2014; 82:721-9. [PMID: 24698849 DOI: 10.1016/j.mehy.2014.03.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 03/08/2014] [Indexed: 11/24/2022]
Abstract
Recent research challenges long-held hypotheses about mechanisms through which pregnancy induces maternal immune suppression or tolerance of the embryo/fetus. It is now understood that normal pregnancy engages the immune system and that the immune milieu changes with advancing gestation. We suggest that pregnancy mimics the innate immune system's response to stress, causing a sterile inflammatory response that is necessary for successful reproduction. The relationship between external stressors and immunomodulation in pregnancy has been acknowledged, but the specific mechanisms are still being explicated. Implantation and the first trimester are times of immune activation and intensive inflammation in the uterine environment. A period of immune quiescence during the second trimester allows for the growth and development of the maturing fetus. Labor is also an inflammatory event. The length of gestation and timing of parturition can be influenced by environmental stressors. These stressors affect pregnancy through neuroendocrine interaction with the immune system, specifically through the hypothalamic-pituitary-adrenal (HPA) axis and the hypothalamic-pituitary-ovarian axis. Trophoblastic cells that constitute the maternal-fetal interface appear to harness the maternal immune system to promote and maximize the reproductive success of the mother and fetus. Pregnancy is a time of upregulated innate immune responses and decreased adaptive, cell-mediated responses. The inflammatory processes of pregnancy resemble an immune response to brief naturalistic stressors: there is a shift from T helper (Th) 1 to T helper (Th) 2 dominant adaptive immunity with a concomitant shift in cytokine production, decreased proliferation of T cells, and decreased cytotoxicity of natural killer (NK) cells. Inclusion of both murine and human studies, allows an exploration of insights into how trophoblasts influence the activity of the maternal innate immune system during gestation.
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Bourke CH, Stowe ZN, Owens MJ. Prenatal antidepressant exposure: clinical and preclinical findings. Pharmacol Rev 2014; 66:435-65. [PMID: 24567054 DOI: 10.1124/pr.111.005207] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Pharmacological treatment of any maternal illness during pregnancy warrants consideration of the consequences of the illness and/or medication for both the mother and unborn child. In the case of major depressive disorder, which affects up to 10-20% of pregnant women, the deleterious effects of untreated depression on the offspring can be profound and long lasting. Progress has been made in our understanding of the mechanism(s) of action of antidepressants, fetal exposure to these medications, and serotonin's role in development. New technologies and careful study designs have enabled the accurate sampling of maternal serum, breast milk, umbilical cord serum, and infant serum psychotropic medication concentrations to characterize the magnitude of placental transfer and exposure through human breast milk. Despite this progress, the extant clinical literature is largely composed of case series, population-based patient registry data that are reliant on nonobjective means and retrospective recall to determine both medication and maternal depression exposure, and limited inclusion of suitable control groups for maternal depression. Conclusions drawn from such studies often fail to incorporate embryology/neurotransmitter ontogeny, appropriate gestational windows, or a critical discussion of statistically versus clinically significant. Similarly, preclinical studies have predominantly relied on dosing models, leading to exposures that may not be clinically relevant. The elucidation of a defined teratological effect or mechanism, if any, has yet to be conclusively demonstrated. The extant literature indicates that, in many cases, the benefits of antidepressant use during pregnancy for a depressed pregnant woman may outweigh potential risks.
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Dutch midwives' behavioural intentions of antenatal management of maternal distress and factors influencing these intentions: An exploratory survey. Midwifery 2014; 30:234-41. [DOI: 10.1016/j.midw.2013.06.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/25/2013] [Accepted: 06/13/2013] [Indexed: 11/23/2022]
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Alexander JL, Dennerstein L, Woods NF, McEwen BS, Halbreich U, Kotz K, Richardson G. Role of stressful life events and menopausal stage in wellbeing and health. Expert Rev Neurother 2014; 7:S93-113. [DOI: 10.1586/14737175.7.11s.s93] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Henriksen L, Vangen S, Schei B, Lukasse M. Sexual violence and antenatal hospitalization. Birth 2013; 40:281-8. [PMID: 24344709 DOI: 10.1111/birt.12063] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Studies have shown the negative impact sexual violence has on pregnancy outcome, yet the impact on antenatal hospitalization has been poorly examined. The aim of this study was to investigate if a history of sexual violence was associated with hospitalization during pregnancy. METHODS A population-based national cohort study conducted by the Institute of Public Health, The Norwegian Mother and Child Cohort study. Women filled out questionnaires at 17 and 30 weeks' gestation. History of sexual violence was reported at three levels: pressured to sexual acts (mild), forced with violence (moderate), and raped (severe). The comparison group did not report sexual violence. Differences were assessed using Pearson's X(2) tests and logistic regression analyses. RESULTS Of 78,660 women, 12.0% were pressured to sexual acts, 2.8% forced with violence, and 3.6% reported rape. A history of sexual violence was associated with significantly more hospitalizations during pregnancy, 6.6 percent for mild, 8.7 percent for moderate and 12.5 percent for severe, compared to 5.8 percent for no sexual violence. Women were significantly more often admitted for hyperemesis, bleeding, threatening preterm birth, other reasons and admitted without giving any reason. Reporting severe sexual violence had an AOR for being hospitalized with hyperemesis or threatening preterm birth of 1.9 (95% CI 1.4-2.5), and 1.9 (1.3-2.7) respectively. Similarly, severe sexual violence was associated with being admitted more than once during pregnancy AOR 1.9 (1.3-2.7). CONCLUSION Women with a history of sexual violence reported significantly more antenatal hospitalizations during pregnancy than women without such a history.
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Affiliation(s)
- Lena Henriksen
- Oslo University Hospital, Section of Obstetrics at the Woman and Children's Division, Oslo University, Oslo, Norway
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40
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Shapiro GD, Fraser WD, Frasch MG, Séguin JR. Psychosocial stress in pregnancy and preterm birth: associations and mechanisms. J Perinat Med 2013; 41:631-45. [PMID: 24216160 PMCID: PMC5179252 DOI: 10.1515/jpm-2012-0295] [Citation(s) in RCA: 185] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 05/14/2013] [Indexed: 01/23/2023]
Abstract
AIMS Psychosocial stress during pregnancy (PSP) is a risk factor of growing interest in the etiology of preterm birth (PTB). This literature review assesses the published evidence concerning the association between PSP and PTB, highlighting established and hypothesized physiological pathways mediating this association. METHOD The PubMed and Web of Science databases were searched using the keywords "psychosocial stress", "pregnancy", "pregnancy stress", "preterm", "preterm birth", "gestational age", "anxiety", and "social support". After applying the exclusion criteria, the search produced 107 articles. RESULTS The association of PSP with PTB varied according to the dimensions and timing of PSP. Stronger associations were generally found in early pregnancy, and most studies demonstrating positive results found moderate effect sizes, with risk ratios between 1.2 and 2.1. Subjective perception of stress and pregnancy-related anxiety appeared to be the stress measures most closely associated with PTB. Potential physiological pathways identified included behavioral, infectious, neuroinflammatory, and neuroendocrine mechanisms. CONCLUSIONS Future research should examine the biological pathways of these different psychosocial stress dimensions and at multiple time points across pregnancy. Culture-independent characterization of the vaginal microbiome and noninvasive monitoring of cholinergic activity represent two exciting frontiers in this research.
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Affiliation(s)
- Gabriel D. Shapiro
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, QC, Canada; and CHU Sainte-Justine Research Center, Université de Montréal, Montréal, QC, Canada
| | - William D. Fraser
- CHU Sainte-Justine Research Center, Université de Montréal, Montréal, QC, Canada; and Department of Obstetrics and Gynecology, Université de Montréal, Montréal, QC, Canada
| | - Martin G. Frasch
- CHU Sainte-Justine Research Center, Université de Montréal, Montréal, QC, Canada; and Department of Obstetrics and Gynecology, Université de Montréal, Montréal, QC, Canada
| | - Jean R. Séguin
- Corresponding author: Jean R. Séguin, Department of Psychiatry Université de Montréal Centre de recherche de l’Hôpital Ste-Justine, Bloc 5, Local 1573 3175 Côte Ste-Catherine Montréal, QC Canada H3T 1C5, Tel.: +1-514-1-345-4931, ext. 4043, Fax: +1-514-345-2176,
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Meltzer-Brody S, Stuebe A. The long-term psychiatric and medical prognosis of perinatal mental illness. Best Pract Res Clin Obstet Gynaecol 2013; 28:49-60. [PMID: 24063973 DOI: 10.1016/j.bpobgyn.2013.08.009] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 06/29/2013] [Accepted: 08/13/2013] [Indexed: 11/30/2022]
Abstract
The perinatal period provides an important window into a woman's long-term health. Perinatal mental illness is a common condition conferring potential serious long-term psychiatric and medical consequences for the mother and family. It is known that childbirth acts as a powerful trigger for depressive episodes in some women, and that women with histories of a mood disorder are particularly vulnerable. Some evidence links perinatal mental illness with obstetrical complications and reduced lactation initiation and duration. Therefore, perinatal mental illness may be a marker for long-term risk, and may contribute directly to subsequent cardiometabolic disease through both neuroendocrine mechanisms and the effects of mental illness on health behaviours. In clinical practice, these associations underscore the importance of screening and treating women with perinatal mental illness to ensure best possible long-term outcomes. Early screening and treatment may both mitigate the primary disease process and reduce the risk of comorbid medical conditions.
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Affiliation(s)
| | - Alison Stuebe
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, NC, USA
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Lassi ZS, Majeed A, Rashid S, Yakoob MY, Bhutta ZA. The interconnections between maternal and newborn health – evidence and implications for policy. J Matern Fetal Neonatal Med 2013; 26 Suppl 1:3-53. [DOI: 10.3109/14767058.2013.784737] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Leung SSK, Lee AM, Chiang VCL, Lam SK, Kuen YW, Wong DFK. Culturally sensitive, preventive antenatal group cognitive-behavioural therapy for Chinese women with depression. Int J Nurs Pract 2013; 19 Suppl 1:28-37. [DOI: 10.1111/ijn.12021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Antoinette M Lee
- Department of Psychiatry; The University of Hong Kong; Hong Kong
| | - Vico CL Chiang
- School of Nursing; Hong Kong Polytechnic University; Hong Kong
| | - SK Lam
- Department of Obstetrics and Gynaecology; The University of Hong Kong; Hong Kong
| | - Yung Wai Kuen
- Department of Obstetrics and Gynaecology; Kwong Wah Hospital; Hong Kong
| | - Daniel FK Wong
- Department of Applied Social Studies; City University of Hong Kong; Hong Kong
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Myors KA, Schmied V, Johnson M, Cleary M. Collaboration and integrated services for perinatal mental health: an integrative review. Child Adolesc Ment Health 2013; 18:1-10. [PMID: 32847263 DOI: 10.1111/j.1475-3588.2011.00639.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND An integrative review was undertaken to synthesise the research related to professionals' perceptions and experiences of working in collaborative and integrated models of perinatal care for women with mental health problems. METHOD A search of the databases CINAHL, Medline, PubMed, Psychinfo and Scopus was conducted. Studies were limited to English language papers published from 2000 to 2010. Fourteen papers were included in the review. RESULTS The overarching theme identified in the review related to the process of 'making it happen'. Eight key elements were identified as central components of this process: funding and resources for collaboration; shared vision, aims and goals; pathways and guidelines; continuity of care; building relationships and trust; role clarity; training and education of staff and support to work in new ways. CONCLUSION Perinatal mental health is an emerging field that is particularly challenging as it requires professionals to work across disciplines and timeframes, where there is a risk of dichotomising care, compounding existing barriers to service uptake. Professionals need resources and to feel supported to change clinical practice and work in more collaborative ways. The voices of women and families are missing in the literature.
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Affiliation(s)
- Karen A Myors
- School of Nursing and Midwifery, The University of Western Sydney, Parramatta Campus, Locked Bag 1797, Penrith South DC, NSW 1797, Australia. E-mail:
| | - Virginia Schmied
- School of Nursing and Midwifery, The University of Western Sydney, Parramatta Campus, Locked Bag 1797, Penrith South DC, NSW 1797, Australia. E-mail:
| | - Maree Johnson
- School of Nursing and Midwifery, The University of Western Sydney, Parramatta Campus, Locked Bag 1797, Penrith South DC, NSW 1797, Australia. E-mail:
| | - Michelle Cleary
- School of Nursing and Midwifery, The University of Western Sydney, Parramatta Campus, Locked Bag 1797, Penrith South DC, NSW 1797, Australia. E-mail:
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Richter J, Bittner A, Petrowski K, Junge-Hoffmeister J, Bergmann S, Joraschky P, Weidner K. Effects of an early intervention on perceived stress and diurnal cortisol in pregnant women with elevated stress, anxiety, and depressive symptomatology. J Psychosom Obstet Gynaecol 2012; 33:162-70. [PMID: 23078196 DOI: 10.3109/0167482x.2012.729111] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The goal of the present investigation was to examine effects of a cognitive-behavioral group intervention for pregnant women with subclinically elevated stress, anxiety and/or depression on perceived stress and salivary cortisol levels. Expectant mothers were recruited in gynaecologist practices. They participated in a screening, a standardized diagnostic interview (Munich-Composite Diagnostic Interview, M-CIDI), and were randomly assigned to an intervention (N = 21) and treatment as usual control group (N = 40). The intervention consisted of a manualized cognitive-behavioral group program for expectant mothers with subclinically elevated stress, depression, and/or anxiety symptoms. Stress questionnaire (prenatal distress (PDQ), perceived stress (PSS)) as well as diurnal salivary cortisol assessment took place at T1 (antenatal, preintervention), at T2 (antenatal, post-intervention) and T3 (3-month postpartum). Subjects that participated in the intervention exhibited a significant post-treatment change in morning cortisol (cortisol awakening response, CAR) in contrast to control subjects, F(8,51) = 2.300, p = 0.047. Intervention participants showed a smaller CAR subsequent to the intervention, displaying a lessened stress reaction. This effect was not observed in the control group. In contrast, we failed in discovering a significant difference between the research groups regarding the cortisol area under curve parameter (AUC) and the applied subjective stress questionnaires. Evaluation results were thus heterogeneous. Nevertheless, intervention effects on the CAR are promising. Our results suggest that a cognitive-behavioral intervention might lead to an improvement in the biological stress response of pregnant women with subclinically elevated stress, anxiety, or depressive symptoms.
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Affiliation(s)
- Judith Richter
- Clinic of Psychotherapy and Psychosomatic Medicine, Technical University of Dresden, Dresden, Germany.
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Menezes LOD, Pinheiro RT, Quevedo LDA, Oliveira SSD, Silva RAD, Pinheiro KAT, Santo GCE, Jansen K. O impacto do baixo peso ao nascer relacionado à depressão gestacional para o financiamento federal da saúde pública: uma análise do Município de Pelotas, Rio Grande do Sul, Brasil. CAD SAUDE PUBLICA 2012; 28:1939-48. [DOI: 10.1590/s0102-311x2012001000012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 07/13/2012] [Indexed: 11/22/2022] Open
Abstract
O baixo peso ao nascer está relacionado com morbimortalidade e sequelas no desenvolvimento infantil, impactando nos custos dos sistemas de saúde, por isso é importante avaliar fatores que o influenciam, estimando seu impacto no Sistema Único de Saúde (SUS). Este é um estudo prospectivo aninhado a uma coorte de gestantes que realizaram pré-natal e parto exclusivamente pelo SUS nos hospitais com UTI da cidade de Pelotas, Rio Grande do Sul, Brasil. Entre os resultados, concluiu-se que mães com episódios de depressão gestacional apresentam quase quatro vezes mais chances de ter um filho com baixo peso ao nascer (RP = 3,94; IC: 1,49-10,36). Valendo-se do cálculo da fração atribuível na população, estima-se que, na população geral, 36,17% dos bebês com baixo peso ao nascer são filhos de mães que tiveram episódio depressivo, estimando-se um custo que pode chegar a mais de R$ 76 milhões no Brasil. Sugere-se que se ampliem as ações preventivas e curativas para as gestantes na área da saúde mental, possibilitando melhor desfecho de saúde dos recém-nascidos, e que se utilizem adequadamente os recursos do SUS.
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Audi CAF, Segall-Corrêa AM, Santiago SM, Pérez-Escamilla R. Adverse health events associated with domestic violence during pregnancy among Brazilian women. Midwifery 2012; 28:356-61. [DOI: 10.1016/j.midw.2011.05.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 04/21/2011] [Accepted: 05/30/2011] [Indexed: 10/17/2022]
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Abstract
Maternal mental health is an important public health issue because of its effects not only on the mother's well-being and functional status, but also her relationship with her partner and the development of her children. There is accumulating evidence of the adverse sequelae of maternal anxiety on fetal development, obstetrical complications, pregnancy outcomes such as low birth weight, and subsequent child development. Evaluation of maternal anxiety and intervention to reduce these symptoms, may ensure optimal developmental outcomes, particularly in high-risk infants such as those born at very low birth weights. This article will outline recent advances in our understanding of the etiology, assessment and impact of maternal anxiety, and describe intervention strategies to promote maternal well-being.
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Affiliation(s)
- Phyllis Zelkowitz
- Department of Psychiatry, Jewish General Hospital & McGill University, Lady Davis Institute, Jewish General Hospital, QC, Canada
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Ortiz Collado MA, Cararach V, Tourne CE. [Preventing the risk of postpartum depression and premature childbirth by a psychosomatic approach: a randomized multicenter study]. Med Clin (Barc) 2012; 139:385-92. [PMID: 22401726 DOI: 10.1016/j.medcli.2011.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 12/14/2011] [Accepted: 12/15/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Randomized studies to assess postnatal depression and preterm childbirth are rarely in conjunction; the 2 problems are treated separately regardless of their common risk factors. The main objective of this study was to evaluate the effects of a prenatal program based on a psychosomatic approach on the risk of postpartum depression (PPD) and preterm childbirth. SUBJECTS AND METHOD Controlled clinical trial, randomized and multicenter study. A total of 184 pregnant women identified as vulnerable to PPD who had psychosocial risk factors associated with preterm childbirth were assigned to the experimental group (EG) (n=92) or control group (CG) (n=92), according to a computerized program. The EG participated in the program with a psychosomatic approach (10 sessions (one/week) for 2 h, 15 m) with a phone call between sessions; the objectives implicated the mother, father and baby contemplating pregnancy, childbirth and postpartum. Women in the EC made the usual program of the health center (8-10 weekly sessions of 2 hours), with no calls, with targets aimed at delivery. There were 2 evaluations: one in pregnancy and another in postpartum (T(1) and T(2)) including symptoms of depression (EPDS), social support (FSSQ), stress (scale events), the relationship (DAS) and the preterm childbirth. RESULTS There was a difference of 11.2 in the percentage of cases at risk of PPD (EPDS≥12): 45.5% (27) in the CG and 34.3% (24) in the EG, without reaching statistical significance (P=.26). The preterm delivery showed significance differences (P=.003), with a decrease in preterm childbirth 4 times lower in the EG. CONCLUSIONS Overall, the percentage of mothers at PPD risk was higher (P=.02) in women with preterm childbirth. It would be appropriate a global obstetrics and psychiatry approach.
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