Depression and anxiety in Singaporean high-risk pregnancies - prevalence and screening

The effect of music therapy on non-stress test results and anxiety levels in high-risk pregnant women: A randomized controlled trial

AIM

This study was conducted to determine the effects of music therapy on non-stress test results and anxiety levels in high-risk pregnant women.

METHODS

This randomized controlled study was conducted in pregnant women who were hospitalized in the High-Risk Pregnancy Service of Meram Medical Faculty Hospital, Konya, Turkey, between April 1 and July 31, 2021. In the intervention group (n = 58), a 20-min music therapy with ney sounds was performed, while in the control group (n = 58), routine care practices were applied. Hüseyni maqam of ney was selected, a melodic mode used by Turks for music therapy. Data were collected using the Descriptive Information Form, the Non-Stress Test Evaluation Form, and the State-Trait Anxiety Inventory.

RESULTS

After music therapy, the intervention group experienced increased mean acceleration (p = 0.010) and foetal movement rates (p < 0.001) while no such difference was observed in the control group. The state anxiety levels of pregnant women differed significantly between the intervention and control groups (p < 0.001). Regression analysis showed that music therapy reduced state anxiety levels in pregnant women by a factor of 4.6 (p < 0.001).

CONCLUSION

Based on the findings, music therapy was found to enhance acceleration and foetal heart rate in high-risk pregnant women while reducing state anxiety levels.

Sub-acute pain after childbirth during COVID-19 pandemic: A secondary analysis of A prospective clinical trial

Background

COVID-19 pandemic could bring great impact upon the psychological statuses of post-partum women, but no clear evidence was provided yet as to COVID-19 would also affect their pain profile during post-partum period. We determined if pain and psychological vulnerabilities, obstetric factors, and labor analgesia were associated with sub-acute pain after childbirth (SAPC; ongoing pain related to delivery at post-partum 4 weeks or more) during COVID-19 pandemic.

Methods

We included women having a singleton pregnancy of ≥36 gestational weeks. The recruited women were given pre-delivery questionnaires to measure their pain and psychological vulnerabilities. At post-partum 6-10 weeks, an online survey was conducted to collect data on post-partum pain information.

Results

Of the 880 recruited women, 816 completed the post-partum pain survey, with 99 (12.1%) having developed SAPC. Giving birth during COVID-19 pandemic (adjusted odds ratio (aOR) 1.64, 95%CI 1.04 to 2.57), greater pre-delivery central sensitization (aOR 1.02, 95%CI 1.00 to 1.04), greater number of pain relief administered (aOR 1.49, 95%CI 1.18 to 1.89), having had artificial rupture of membrane and oxytocic during labor onset (aOR 3.00, 95%CI 1.66 to 5.40), greater volume of blood loss during delivery (every 100 ml; aOR 1.27, 95%CI 1.11 to 1.44), having had third-degree tear during delivery (aOR 4.40, 95%CI 1.33 to 14.51), and greater infant height (aOR 1.14, 95%CI 1.01 to 1.30) were independently associated with greater risk of SAPC. Having greater general health score was protective against the risk of SAPC (aOR 0.99, 95% CI 0.97 to 0.999) (Area under the curve (AUC) = 0.74).

Conclusions

The generated multivariable association model may help us better understand the shift in pain and psychological aspects of women during COVID-19 pandemic.

Validation of the culturally adapted Edinburgh postpartum depression scale among east Asian, southeast Asian and south Asian populations: A scoping review

The Edinburgh Postnatal Depression Scale (EPDS) is a widely used self-report instrument to screen for postpartum depression (PPD). Assessing the relevance of the EPDS as a screening tool for minority ethnic populations is pertinent for ensuring culturally appropriate care. This scoping review aimed to explore what is known about the cultural adaptations of the EPDS in antepartum and postpartum mothers and fathers in East Asian, Southeast Asian and South Asian populations, and to what extent these adaptations are able to accurately screen for postpartum depression symptoms among these cultural groups. The scoping review was guided by the PRISMA-ScR checklist. The search strategy included databases of MEDLINE, PsycINFO, EMBASE, CINAHL and Grey literature. Included studies were primary articles published in English language peer-reviewed journals that investigated the validation or cultural adaptation of the EPDS in mothers who were pregnant and/or had recently given birth, or fathers who were new parents, and were limited to the following cultural groups, whether living locally or abroad in a foreign country: East Asian, Southeast Asian or South Asian populations. Thirty-six of 2469 studies met criteria for inclusion. Twenty-one of 36 studies utilizing a culturally validated EPDS demonstrated a cut-off score lower than the original recommended cut-off. Important themes identified included the Role of Culture, Somatization of PPD, Method of Interview, and contrasting performance compared to other scales used to assess depression and/or anxiety. Accessibility to translated and validated EPDS and mindfulness of ethnically relevant EPDS cut-off scores are critical when using this tool among minority ethnic populations.

Psychological distress in pregnancy and postpartum: a cross-sectional study of Babol pregnancy mental health registry

BACKGROUND

Psychological distress (PD) is a significant issue during pregnancy and postpartum, adversely affecting both children and mothers. This study aims to determine PD's prevalence and risk factors in a large Iranian population sample during pregnancy and postpartum.

METHODS

A cross-sectional study was conducted using data from the Babol Pregnancy Mental Health Registry (located in the north of Iran) between June 2020 and March 2021. A total of 2305 women were included, with 1639 during pregnancy and 666 during postpartum. Psychological distress was assessed using the Brief Symptoms Inventory (BSI-18), and data were analyzed using independent t-tests and multiple logistic regressions.

RESULTS

The prevalence of psychological distress, defined by a cut-off score of BSI ≥ 13, was 19% during pregnancy and 15% during postpartum. Multivariate logistic analysis revealed that high-risk pregnancy was the leading risk factor for psychological distress during the antenatal period (β = 1.776, P < 0.001), as well as its three subscales: somatization (β = 1.355, P = 0.019), anxiety symptoms (β = 2.249, P < 0.001), and depressive symptoms (β = 1.381, P = 0.028). Additionally, women with a gestational age < 20 weeks had a higher risk of psychological distress (β = 1.344, P = 0.038) and the somatization subscale (β = 1.641, P < 0.001). During the postpartum period, women residing in urban areas were at higher risk of psychological distress (β = 1.949, P = 0.012), as well as two subscales: anxiety symptoms (β = 1.998, P = 0.012) and depressive symptoms (β = 1.949, P = 0.020).

CONCLUSION

The high prevalence of psychological distress emphasizes detecting and treating PD during pregnancy and postpartum, particularly in women with high-risk pregnancies. This study suggests that obstetricians and midwives should implement programs to identify women experiencing psychological distress during early pregnancy through postpartum visits.

Consensus statement on Singapore Perinatal Mental Health Guidelines on Depression and Anxiety

Introduction

Perinatal depression and anxiety are public health concerns affecting approximately 1 in 10 women in Singapore, with clear evidence of association with various adverse outcomes in mother and child, including low birthweight, preterm birth and negative impact on infant neurodevelopment, temperament and behaviour. A workgroup was formed to develop recommendations to address the perinatal mental health needs of women with depression and anxiety. The approach was broad-based and aimed to incorporate holistic methods that would be readily applicable to the network of care providers supporting childbearing women.

Method

The Grading and Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision framework was employed to draw these guidelines. Workgroup members-comprising experts in the field of perinatal mental health and obstetric medicine-deliberated on the public health needs of the target population, and reviewed literature published from 2001 to 2022 that were relevant to improve the well-being of women with depression and anxiety during the preconception and perinatal periods.

Results

A consensus meeting was held involving a wider professional network, including family physicians, paediatricians, psychiatrists, social services and the Health Promotion Board in Singapore.

Conclusion

Ten consensus statements were developed, focusing on the overall aim of achieving optimal perinatal mental health for women with depression and anxiety. They relate to awareness and advice on preconception mental health, screening and assessment, optimising care and treatment. Special considerations were recommended for women who suffered severe maternal events, tailoring care for adolescents and women with special needs, and addressing infant mental health needs.

Digital health technologies for peripartum depression management among low-socioeconomic populations: perspectives from patients, providers, and social media channels

BACKGROUND

Peripartum Depression (PPD) affects approximately 10-15% of perinatal women in the U.S., with those of low socioeconomic status (low-SES) more likely to develop symptoms. Multilevel treatment barriers including social stigma and not having appropriate access to mental health resources have played a major role in PPD-related disparities. Emerging advances in digital technologies and analytics provide opportunities to identify and address access barriers, knowledge gaps, and engagement issues. However, most market solutions for PPD prevention and management are produced generically without considering the specialized needs of low-SES populations. In this study, we examine and portray the information and technology needs of low-SES women by considering their unique perspectives and providers' current experiences. We supplement our understanding of women's needs by harvesting online social discourse in PPD-related forums, which we identify as valuable information resources among these populations.

METHODS

We conducted (a) 2 focus groups (n = 9), (b) semi-structured interviews with care providers (n = 9) and low SES women (n = 10), and (c) secondary analysis of online messages (n = 1,424). Qualitative data were inductively analyzed using a grounded theory approach.

RESULTS

A total of 134 open concepts resulted from patient interviews, 185 from provider interviews, and 106 from focus groups. These revealed six core themes for PPD management, including "Use of Technology/Features", "Access to Care", and "Pregnancy Education". Our social media analysis revealed six PPD topics of importance in online messages, including "Physical and Mental Health" (n = 725 messages), and "Social Support" (n = 674).

CONCLUSION

Our data triangulation allowed us to analyze PPD information and technology needs at different levels of granularity. Differences between patients and providers included a focus from providers on needing better support from administrative staff, as well as better PPD clinical decision support. Our results can inform future research and development efforts to address PPD health disparities.

Association of social capital with mental health and quality of life among low- and high-risk pregnant women

INTRODUCTION

Social capital means having resources and support in relationships and social ties. It can affect the individual's quality of life and mental health. The present study investigated the association between social capital with psychological status and quality of life among low-risk and high-risk pregnant women.

METHODS

The present cross-sectional study was conducted with the participation of 394 pregnant women receiving prenatal care in urban comprehensive health centers in Qazvin, Iran. Two-stage sampling was used to select comprehensive health centers by random cluster sampling and then pregnant women randomly. Social capital, quality of life (QoL), psychological status, and demographic and obstetric characteristics were assessed. Uni-variable and multivariable linear regression models were used to analyze the data.

RESULTS

Among the participants, 267 had low-risk pregnancies (67.77%) and the remainder were high-risk. The mean age of participants was 27.94 years (SD=5.86), the mean gestational age was 23.63 weeks (SD=7.71). The mean overall quality of life score among low-risk pregnant women was 32.00 (SD=5.27) and among high-risk pregnant women was 29.70 (SD=3.65). High-risk pregnant women experienced significantly higher anxiety and depression and fear of COVID-19. Social capital had a significant and weak relationship with anxiety among low-risk pregnant women (r = 0.22, p < 0.001). Also, a weak and significant relationship between social capital and anxiety (r = 0.24, p = 0.007), depression (r = 0.24, p = 0.007) and fear of COVID-19 (r = 0.27, p = 0.002) was found among high-risk pregnant women.

CONCLUSION

Women with high-risk pregnancies experienced lower quality of life, higher anxiety and depression, and greater fear of COVID-19. There was also a weak relationship between social capital and the aforementioned variables among high-risk pregnant women. Designing and implementing interventions to increase quality of life and reduce anxiety and stress among high-risk pregnant women appears to be warranted.

The Effect of Selenium Supplementation on Clinical Outcomes, Metabolic Profiles, and Pulsatility Index of the Uterine Artery in High-Risk Mothers in Terms of Preeclampsia Screening with Quadruple Test: a Randomized, Double-Blind, Placebo-Controlled Clinical Trial : Selenium and preeclampsia

Data on the effects of selenium (Se) supplementation on clinical outcomes, metabolic profiles, and pulsatility index (PI) in high-risk mothers in terms of preeclampsia (PE) screening with quadruple tests are scarce. This study evaluated the effects of Se supplementation on clinical outcomes, metabolic profiles, and uterine artery PI on Doppler ultrasound in high-risk mothers in terms of PE screening with quad marker. The current randomized, double-blind, placebo-controlled trial was conducted among 60 high-risk pregnant women screening for PE with quad tests. Participants were randomly allocated into two groups (30 participants each group), received either 200 µg/day Se supplements (as Se amino acid chelate) or placebo from 16 to 18 weeks of pregnancy for 12 weeks. Clinical outcomes, metabolic profiles, and uterine artery PI were assessed at baseline and at the end of trial. Se supplementation resulted in a significant elevation in serum Se levels (β 22.25 µg/dl; 95% CI, 18.3, 26.1; P < 0.001) compared with the placebo. Also, Se supplementation resulted in a significant elevation in total antioxidant capacity (β 82.88 mmol/L; 95% CI, 3.03, 162.73; P = 0.04), and total glutathione (β 71.35 µmol/L; 95% CI, 5.76, 136.94; P = 0.03), and a significant reduction in high-sensitivity C-reactive protein levels (β - 1.52; 95% CI, - 2.91, - 0.14; P = 0.03) compared with the placebo. Additionally, Se supplementation significantly decreased PI of the uterine artery in Doppler ultrasound (β - 0.09; 95% CI, - 0.14, - 0.04; P = 0.04), and a significant improvement in depression (β - 5.63; 95% CI, - 6.97, - 4.28; P < 0.001), anxiety (β - 1.99; 95% CI, - 2.56, - 1.42; P < 0.001), and sleep quality (β - 1.97; 95% CI, - 2.47, - 1.46; P < 0.001). Se supplementation for 12 weeks in high-risk pregnant women in terms of PE screening with quad marker had beneficial effects on serum Se level, some metabolic profiles, uterine artery PI, and mental health. IRCT Registration: htpp:// www.irct.ir ; identifier IRCT20200608047701N1.

Mid‐pregnancy and postpartum maternal mental health and infant sleep in the first year of life

Perinatal depression and anxiety are common and associated with sleep problems in the offspring. Depression and anxiety are commonly comorbid, yet often studied independently. Our study used an integrative measure of anxiety and depressive symptoms to examine the associations of maternal mental health (mid-pregnancy and postnatal) with infant sleep during the first year of life. A total of 797 mother-child dyads from the 'Growing Up in Singapore Towards healthy Outcome' cohort study provided infant sleep data at 3, 6, 9 and 12 months of age, using the caregiver reported Brief Infant Sleep Questionnaire. Maternal mental health was assessed at 26-28 weeks gestation and 3 months postpartum using the Edinburgh Postnatal Depression Scale, Beck Depression Inventory and State-Trait Anxiety Inventory. Bifactor modelling with the individual questionnaire items produced a general affect factor score that provided an integrated measure of anxiety and depressive symptoms. Linear mixed models were used to model the sleep outcomes, with adjustment for maternal age, education, parity, ethnicity, sex of the child and maternal sleep quality concurrent with maternal mental health assessment. We found that poorer mid-pregnancy, but not postpartum, maternal mental health was associated with longer wake after sleep onset duration across the first year of life (β = 49, 95% confidence interval 13-85 min). Poor maternal mental health during mid-pregnancy is linked to longer period of night awakening in the offspring during infancy. Interventions that aim to improve maternal antenatal mental health should examine infant sleep outcomes.

Psychosocial well-being in postpartum women with congenital heart disease

Background

Improved treatment options for congenital heart disease (CHD) lead to a growing number of women with CHD at reproductive age. Due to physical and psychological burden, pregnancies in women with CHD often count for high-risk. Resulting emotional distress can adversely impact pregnancy, motherhood and fetal health. The present study aims to retrospectively investigate mental outcomes and indices of adjustment in women with CHD before, during and after pregnancy. The novel concept of illness identity is applied to explain how patients experience and integrate their CHD into their identities.

Methods

Patient-reported outcome measures on mental functioning and illness identity were assessed in a sample of 121 postpartum women with CHD [mean age: 42.7±9.2 (range, 27-81) years] at the German Heart Centre Munich between August and November 2021 in a cross-sectional design. Descriptive analyses, correlations and linear regression models were calculated.

Results

Retrospectively assessed prevalence of emotional distress before giving birth was high (47.0%) and peaked shortly after childbirth in terms of elevated symptoms of postpartum depression and trauma. During the course of maternity, emotional distress decreased significantly (24.1%, P<0.001). Overall, postpartum women demonstrated high scores in functional illness identity states (i.e., acceptance and enrichment) and low scores in dysfunctional states (i.e., rejection and engulfment). CHD severity was not directly associated with mental outcomes (P>0.05), whereas maternal cardiovascular risk, according to the WHO classification, was significantly associated with a higher prevalence of postpartum trauma (t=2.485, P=0.015).

Conclusions

Postpartum mental health problems, such as (postpartum) depression, anxiety, and posttraumatic stress can become a serious burden which might be detrimental to the mother's well-being and her infant's development. Present findings emphasise the urgent need for a holistic approach focusing on pregnant women with CHD starting at the prepartum stage to prevent adverse consequences and promote maternal well-being. Illness identity might become an important target construct for clinical practice as it may positively and enduringly influence mental well-being of pregnant women with CHD.

Factors associated with women's preferences for labor epidural analgesia in Singapore: a survey approach

Epidural analgesia provides effective pain relief during labor. However, there is limited information on the factors associated with pregnant women’s preferences for labor epidural analgesia (LEA) prior to labor onset. We performed a secondary analysis of a clinical trial to identify demographic characteristics, pain and psychological vulnerability factors associated with preferences for LEA. Pregnant women at ≥ 36 weeks’ gestation prior to labor and delivery were recruited and given questionnaires on their LEA preferences, psychological and pain vulnerabilities. The primary outcome was the association between pre-delivery Edinburgh Postnatal Depression Scale (EPDS) with cut-off ≥ 10 and LEA preference. Of the 250 women recruited, 51.6% (n = 129) indicated “yes to LEA”. Amongst those considering LEA as an option to reduce labor pain, women who preferred to use LEA (n = 129) indicated favorable or neutral opinion. Additionally, 68% (n = 82) from those “no to LEA” or “not sure about LEA” still gave either favorable or neutral opinion for LEA (p < 0.0001). The multivariate logistic regression analysis found that EPDS ≥ 10 (p < 0.01), occupation (p = 0.03), ethnicity (p < 0.01), state anxiety (p = 0.02), mode of current pregnancy (unplanned; planned, assisted; planned, natural; p = 0.03) and premenstrual anger/irritability before current pregnancy (p = 0.02) were associated with LEA preference. The findings may help to define the population that may require further education on considering LEA and allow early identification on different LEA preferences to provide patient centric care prior to labor and delivery.

The impact of Covid-19 restrictions on depressive symptoms in low-risk and high-risk pregnant women: a cross-sectional study before and during pandemic

Background

The COVID-19 social restrictions have increased the risk for depression compared to the previous period in Italian women with Low-Risk Pregnancy (LRP). lLess is known about the impact of COVID-19 restrictions on High-Risk Pregnancy (HRP). This study aimed: 1) to explore levels of depression in women who become pregnant before and during COVID-19 pandemic, distinguishing between LRP and HRP; 2) to analyze the impact of COVID-19 restrictions on pregnancy experience in LRP and HRP.

Methods

A before-during COVID-19 pandemic cross-sectional study was carried out on 155 pregnant women (Mean age = 34.18), between 23 and 32 weeks of gestation. 77 women were recruited before COVID-19 pandemic (51.9% LRP; 48.1% HRP) and 78 women were recruited during COVID-19 pandemic (51.3% LRP; 48.7% HRP). HRP group was enrolled during hospitalization for high-risk pregnancy. Participants filled out Edinburgh Postnatal Depression Scale. Moreover, only COVID-19 group answered an open-ended question about the impact of restriction on pregnancy experience.

Results

HRP women reported higher levels of depressive symptoms than LRP. No difference emerged for COVID (before/during) but an interaction effect between COVID-19 and obstetric condition was found. The qualitative results showed the impact of restrictions on emotions and concerns.

Conclusion

Respect to the previous period, LRP women during COVID-19 presented an increased risk for depressive symptoms than HRP. The HRP women during COVID-19 seemed to use hospitalization as a resource to find a social support network with other pregnant women and to be reassured on the clinical ongoing of pregnancy.

Psychological well-being of women at high risk of spontaneous preterm birth cared for in a specialised preterm birth clinic: a prospective longitudinal cohort study

OBJECTIVES

To assess the psychological well-being of pregnant women at increased risk of spontaneous preterm birth, and the impact of care from a preterm birth clinic.

DESIGN

Single-centre longitudinal cohort study over 1 year, 2018-2019.

SETTING

Tertiary maternity hospital in Auckland, New Zealand.

PARTICIPANTS

Pregnant women at increased risk of spontaneous preterm birth receiving care in a preterm birth clinic.

INTERVENTION

Participants completed three sets of questionnaires (State-Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale, and 36-Item Short Form Survey)-prior to their first, after their second, and after their last clinic appointments. Study-specific questionnaires explored pregnancy-related anxiety and perceptions of care.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the mean State-Anxiety score. Secondary outcomes included depression and quality of life measures.

RESULTS

73/97 (75.3%) eligible women participated; 41.1% had a previous preterm birth, 31.5% a second trimester loss and 28.8% cervical surgery; 20.6% had a prior mental health condition. 63/73 (86.3%) women completed all questionnaires. The adjusted mean state-anxiety score was 39.0 at baseline, which decreased to 36.5 after the second visit (difference -2.5, 95% CI -5.5 to 0.5, p=0.1) and to 32.6 after the last visit (difference -3.9 from second visit, 95% CI -6.4 to -1.5, p=0.002). Rates of anxiety (state-anxiety score >40) and depression (Edinburgh Postnatal Depression Scale score >12) were 38.4%, 34.8%, 19.0% and 13.7%, 8.7%, 9.5% respectively, at the same time periods. Perceptions of care were favourable; 88.9% stated the preterm birth clinic made them significantly or somewhat less anxious and 87.3% wanted to be seen again in a future pregnancy.

CONCLUSIONS

Women at increased risk of spontaneous preterm birth have high levels of anxiety. Psychological well-being improved during the second trimester; women perceived that preterm birth clinic care reduced pregnancy-related anxiety. These findings support the ongoing use and development of preterm birth clinics.

Screening of psychiatric disorders in women with high‐risk pregnancy: Accuracy of three psychological tools

Purpose

This study investigated the optimal cutoff points of three psychological tools for screening psychiatric disorders in women with high‐risk pregnancy.

Design and Methods

In this cross‐sectional study (N = 155), sensitivity/specificity of the Edinburgh Postnatal Depression Scale (EPDS), the Brief Symptom Inventory 53‐items (BSI‐53), and the BSI‐18 were computed with respect to having a psychiatric diagnosis based on the clinical interview.

Results

The usual cutoffs (≥13 for EPDS, T‐score of 63 for BSI‐53) demonstrated poor diagnostic accuracy. The optimal thresholds were computed for EPDS cutoff of 6.5, GSI = 0.47 for BSI‐53, and GSI = 0.5 for BSI‐18.

Practice Implications

The use of psychological tools among pregnant women with high‐risk pregnancy may need to be modified in order to accurately identify psychiatric disorders.

A Prospective Study of the Relationship Between Sleep Quality and Depression in Pregnancy

Objective

Poor sleep and depression are common problems during pregnancy, but there has been little investigation into the association between them. This prospective study aims to examine the relationship between sleep quality and depression during pregnancy.

Methods

Pregnant women under 14 weeks’ gestation attending routine outpatient antenatal care in Singapore’s largest maternity hospital were recruited between 2012 and 2014. Women with multiple pregnancies and deemed at high risk of miscarriage were excluded. Six hundred and forty participants completed the Pittsburgh Sleep Quality Index (PSQI) and Edinburgh Postnatal Depression Scale (EPDS) at the three trimesters during pregnancy.

Results

Mean PSQI score was highest in the third visit, suggesting poorer quality sleep in the late third trimester compared to other trimesters. 15.6% of participants at each time point fulfilled the criteria for antenatal depression according to the EPDS cut-off score > 14. PSQI scores were significantly correlated with EPDS scores, and also prospectively predicted EPDS scores in all three trimesters.

Conclusion

Sleep quality in Singaporean pregnant women was poorest in the third trimester, and was associated with the development of depressive symptoms. With more than 1 in 10 women having antenatal depression, interventions targeting sleep quality might be particularly beneficial.

Comorbid Anxiety and Depression and Related Factors Among Pregnant and Postpartum Chinese Women During the Coronavirus Disease 2019 Pandemic

Objective: To identify the prevalence of comorbid anxiety and depression (CAD) and analyze the relationship between CAD and sociodemographic and obstetric-related variables in pregnant and postpartum Chinese women during the COVID-19 pandemic. Methods: Participants were 2,237 pregnant and postpartum women (aged 19-47 years) who visited various medical institutions in China between February 28, 2020, and April 26, 2020. They were asked to complete an online survey assessing the anxiety and depression, obstetric characteristics, and sociodemographic variables. The women were grouped into the following categories in accordance with the Generalized Anxiety Disorder Scale-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9): (a) CAD, (b) "anxiety only," (c) "depression only," and (d) "no depression or anxiety." After estimating the prevalence of CAD, "anxiety only," and "depression only," we carried out chi-squared tests and multiple logistic regression analysis to examine the related factors between these groups of pregnant and postpartum Chinese women. Results: Comorbid anxiety and depression, "anxiety only," and "depression only," occurred in 6.3, 5.8, and 3.9% of participants, respectively. The prevalence rates of CAD during the first, second, and third trimesters of pregnancy and the postpartum period were found to be 7.4, 6.5, 5.7, and 8.2%, respectively. The factors that differed among the groups were age (p < 0.05), marital status (p < 0.001), level of education (p < 0.05), family support (p < 0.001), and total live births (p < 0.001). "Poor family support" (odds ratio (OR): 1.90; 95% confidence interval (CI): 1.30-2.78; p = 0.0009) and "no birth" (OR: 1.91; 95% CI: 1.32-2.75; p = 0.0006) remained significant factors for the CAD group, while "poor family support" (OR: 2.16; 95% CI: 1.34-3.47; p = 0.0015) remained a significant factor for the "depression only" group when their results were compared to those of the "no depression or anxiety" group in the multiple logistic regression analysis. Conclusion: Pregnant and postpartum Chinese women with poor family support and primipara are at high risk for CAD during the COVID-19 pandemic. These results support the need for targeted perinatal programs to address CAD in pregnant and postpartum women during the pandemic period.

Selective cutoff reporting in studies of the accuracy of the Patient Health Questionnaire-9 and Edinburgh Postnatal Depression Scale: Comparison of results based on published cutoffs versus all cutoffs using individual participant data meta-analysis

OBJECTIVES

Selectively reported results from only well-performing cutoffs in diagnostic accuracy studies may bias estimates in meta-analyses. We investigated cutoff reporting patterns for the Patient Health Questionnaire-9 (PHQ-9; standard cutoff 10) and Edinburgh Postnatal Depression Scale (EPDS; no standard cutoff, commonly used 10-13) and compared accuracy estimates based on published cutoffs versus all cutoffs.

METHODS

We conducted bivariate random effects meta-analyses using individual participant data to compare accuracy from published versus all cutoffs.

RESULTS

For the PHQ-9 (30 studies, N = 11,773), published results underestimated sensitivity for cutoffs below 10 (median difference: -0.06) and overestimated for cutoffs above 10 (median difference: 0.07). EPDS (19 studies, N = 3637) sensitivity estimates from published results were similar for cutoffs below 10 (median difference: 0.00) but higher for cutoffs above 13 (median difference: 0.14). Specificity estimates from published and all cutoffs were similar for both tools. The mean cutoff of all reported cutoffs in PHQ-9 studies with optimal cutoff below 10 was 8.8 compared to 11.8 for those with optimal cutoffs above 10. Mean for EPDS studies with optimal cutoffs below 10 was 9.9 compared to 11.8 for those with optimal cutoffs greater than 10.

CONCLUSION

Selective cutoff reporting was more pronounced for the PHQ-9 than EPDS.

Effects of a Case Management Program for Women With Pregnancy-Induced Hypertension

BACKGROUND

Pregnancy-induced hypertension (PIH) is a leading cause of maternal and fetal morbidity and mortality. Although case management programs have been proposed to improve maternal and fetal outcomes in high-risk pregnancies, limited data are available regarding the effect of case management on women with PIH.

PURPOSE

The aim of this study was to evaluate the effect of an antepartum case management program on stress, anxiety, and pregnancy outcomes in women with PIH.

METHODS

A quasi-experimental research design was employed. A convenience sample of women diagnosed with PIH, including preeclampsia, was recruited from outpatient clinics at a medical center in southern Taiwan. Sixty-two women were assigned randomly to either the experimental group (n = 31) or the control group (n = 31). The experimental group received case management for 8 weeks, and the control group received routine clinical care. Descriptive statistics, independent t or Mann-Whitney U tests, chi-square or Fisher's exact tests, paired t test, and generalized estimating equations were used to analyze the data.

RESULTS

The average age of the participants was 35.1 years (SD = 4.5). No significant demographic or clinical differences were found between the control and experimental groups. The results of the generalized estimating equations showed significantly larger decreases in stress and anxiety in the experimental group than in the control group. No significant differences were identified between the two groups with respect to infant birth weeks, infant birth weight, average number of medical visits, or frequency of hospitalization.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The nurse-led case management program was shown to have short-term positive effects on the psychosocial outcomes of a population of Taiwanese patients with PIH. These results have important clinical implications for the healthcare administered to pregnant women, particularly in terms of improving the outcomes in those with PIH.

Anxiety and depression in women hospitalized due to high-risk pregnancy: An integrative quantitative and qualitative study

Literature has shown that hospitalized women with high-risk pregnancy tend to develop anxious and depressive symptoms. Research has used quantitative or qualitative methods. By integrating both quantitative and qualitative methods, this study aims to analyze: a) the level of depression, anxiety, and pregnancy-related anxiety in a group of women hospitalized with high-risk pregnancy (hospitalized high-risk) compared with a group of non-hospitalized women with low-risk pregnancy; b) the content of hospitalization-related emotions in a high-risk group. A cross-sectional study was conducted on 30 hospitalized high-risk pregnant women and 32 women with low-risk pregnancy. Participants completed the Edinburgh Postnatal Depression Scale, Hospital Anxiety and Depression Scale (Anxiety), and Pregnancy Related Anxiety Questionnaire. The hospitalized high-risk group also completed open-ended questions about emotions experienced during hospitalization. Univariate Analysis of Covariance showed that the hospitalized high-risk group reported higher general anxiety and depression than the low-risk pregnancy group. Low-risk group reported higher level of concerns about own appearance than high-risk group. Narratives showed that the anxious and depressive symptoms of hospitalized women are related to the loneliness of being away from family. Despite attempts to understand hospitalization, they express concerns about pregnancy. Psychological support for hospitalized pregnant women should be provided to facilitate the communication of emotions that leads women to elaborate the experience of hospitalization to better adapt and cope with the critical condition.

Prevalence of Depression or Anxiety During Antepartum Hospitalizations for Obstetric Complications: A Systematic Review and Meta-analysis

OBJECTIVE

To systematically review the prevalence of antenatal depression and anxiety in women hospitalized in an antepartum unit for obstetric complications.

DATA SOURCES

We searched PubMed, EMBASE, CINAHL, PsycINFO, and ClinicalTrials.gov for English-language articles published from database inception through March 2020.

METHODS OF STUDY SELECTION

We included cross-sectional, cohort, case-control, quasi-experimental, and randomized controlled studies from any country that reported the proportion of pregnant women with an elevated depression or anxiety screening scale or diagnostic interview during antepartum hospitalization of any duration and at any gestational age.

TABULATION, INTEGRATION, AND RESULTS

We identified 8,799 articles and reviewed 79, 39 of which were included in a systematic review and 18 in meta-analysis of the primary outcome. Two raters independently assessed quality of individual studies using a 14-question tool. A random effects meta-analysis model was used to estimate prevalence and 95% CI of depression or anxiety. Heterogeneity was examined with the I2 test, and funnel plots were used to assess publication bias. After meta-analysis, the estimated prevalence of depression was 34% (95% CI 27-41%) and of anxiety 29% (95% CI 16-43%). There was expected substantial clinical and methodologic heterogeneity between studies that persisted even after planned a priori subgroup analyses and meta-regression. Even so, the direction of effect was consistent across studies. No publication bias was found.

CONCLUSION

The current meta-analysis suggests that one in three women hospitalized during pregnancy for obstetric complications report clinical levels of depression or anxiety symptoms, twice the reported prevalence of antenatal depression or anxiety in the general obstetric population.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, CRD42020172111.

The effect of stress management training on perceived stress, anxiety and hopelessness levels of women with high-risk pregnancy

The aim of this study was to investigate the effect of stress management training on the perceived stress, anxiety and hopelessness levels of women with high-risk pregnancy. The sample of this experimental study consisted of 206 high-risk pregnant women (intervention = 103; control = 103). Data were collected using a Personal Information Form, the Perceived Stress Scale, the Beck Hopelessness Scale and the State-Trait Anxiety Inventory. In the second follow-up after the training, there was a statistically significant difference amongst the Perceived Stress Scale, Beck Hopelessness Scale and State-Trait Anxiety Inventory mean scores in the intervention and control groups (p < .05). Perceived stress scores of the control group who did not receive training during discharge increased. The state and trait anxiety scores and hopelessness scores of the intervention group received training decreased compared with the control group.IMPACT STATEMENTWhat is already known on this subject? Mental problems such as anxiety and stress are more common in high-risk pregnancies compared with healthy pregnancies.What do the results of this study add? After the training 51.4% of women in the intervention group, 75.7% of women in the control group had stress. The state and trait anxiety and hopelessness scores of the intervention group having training decreased compared to the control group.What are the implications of these findings for clinical practice and/or further research? Health professionals should provide stress management training in high-risk pregnant women to reducing perceived stress, anxiety and hopelessness levels.

Comorbid anxiety and depression: Prevalence and associated factors among pregnant women in Arba Minch zuria district, Gamo zone, southern Ethiopia

Introduction

Prenatal anxiety and depression are major health problems all over the world. The negative sequela of prenatal comorbid anxiety and depression (CAD) has been suggested to be higher than that of anxiety or depression alone. CAD increases the odds of preterm birth, low birth weight, prolonged labor, operative deliveries, postpartum psychiatric disorders and long term cognitive impairment for the newborn. Despite its significant ill consequences, there is a dearth of studies in low-and middle-income countries. So far, to the best of our knowledge, no study assessed the prevalence of CAD in Ethiopia. Hence, the purpose of this study was to assess CAD and associated factors among pregnant women in Arba Minch Zuria district, Gamo zone, southern Ethiopia.

Methods

A community-based cross-sectional study was conducted among 676 pregnant women from January 01 to November 30, 2019. Patient Health Questionnaire 9-item (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) scales were used to assess depression and anxiety respectively. The data were collected electronically using an open data kit (ODK) collect android application and analyzed using Stata version 15.0. Bivariate and multivariable analyses were carried out to identify factors associated with CAD using binary logistic regression. Statistical significance was set at p-value < 0.05.

Results

A total of 667 women were involved. The prevalence of CAD was 10.04% [95% confidence interval (CI): 7.76, 12.33]. Being married [adjusted odds ratio (AOR): 0.16, 95% CI: 0.05, 0.56], categorized in the highest wealth quintile [AOR: 2.83, 95% CI: 1.17, 6.84], having medical illness [AOR: 3.56, 95% CI: 1.68, 7.54], encountering pregnancy danger signs [AOR: 2.66, 95% CI: 1.06, 6.67], experiencing life-threatening events [AOR: 2.11, 95% CI: 1.15, 3.92] and household food insecurity [AOR: 3.51, 95% CI: 1.85, 6.64] were significantly associated with CAD.

Conclusions

In general, one in every ten women faced CAD in the study area. Nutritional interventions, early identification and treatment of pregnancy-related illness and medical ailments, prenatal mental health problems screening and interventions are imperative to minimize the risk of CAD in pregnant women.

Prevalence and onset of anxiety and related disorders throughout pregnancy: A prospective study in an Australian sample

The aims of this study were to investigate the prevalence of anxiety and related disorders (e.g., obsessive-compulsive disorder [OCD]) and major depressive disorder (MDD) at any time during pregnancy and during each pregnancy trimester and ascertain the proportions of women with an onset of these disorders during pregnancy. Several questionnaires and the Mini International Neuropsychiatric Interview were administered to 200 women at each pregnancy trimester. Complete data were obtained from 148 participants. The most prevalent anxiety disorder at any time during pregnancy was panic disorder (PD), followed by generalised anxiety disorder (GAD) and OCD. Unlike all the other disorders, the prevalence rates of OCD increased steadily from the first to the third trimester. Approximately one half of women with OCD and about one third of women with PD, GAD and MDD at any time during pregnancy had an onset of these disorders during pregnancy. Pregnancy may be a risk factor for an onset of OCD and to a lesser extent, for an onset of PD, GAD and MDD. Absence of remission of OCD during pregnancy despite treatment may suggest treatment resistance of OCD at this time. These findings have implications for recognition, prevention and treatment of anxiety disorders during pregnancy.

Association of Childbirth Pain with Postnatal Depressive and Anxiety Disorders in Nulliparous Parturients: A Prospective Study

PURPOSE

There is limited knowledge on the relationship between postnatal depression and childbirth pain characteristics associated with childbirth. We investigated whether the characteristics of childbirth pain, as assessed by Short-form-McGill Pain Questionnaire-2 (SF-MPQ-2), were associated with postnatal anxiety and depressive disorders.

PATIENTS AND METHODS

Nulliparous parturients who received labor epidural analgesia (LEA) and delivered in our institution were invited to have a Mini-International Neuropsychiatric Interview (MINI) assessment following their 5-9 weeks post-delivery follow-up phone survey of a larger study. Parturients' demographics, pre-delivery questionnaires on pain and psychological vulnerabilities, LEA data, maternal and neonatal outcomes, postnatal follow-up survey on pain and psychological vulnerabilities, pain and breastfeeding were collected accordingly. The primary outcome was the binary variable (yes/no) of the presence of postnatal depression and/or anxiety disorders based on the post-delivery MINI assessment.

RESULTS

Among the 107 parturients who participated in the post-delivery MINI assessment, a total of 40 (42.5%) patients were found to have postnatal anxiety and depressive disorders. A greater pre-delivery SF-MPQ-2 neuropathic pain mean subscale score (adjusted odds ratio (OR) 1.32, 95% CI 1.00-1.73, p=0.0482) and greater post-delivery Edinburgh Postnatal Depression Scale (EPDS) at 5-9 weeks post-delivery (adjusted OR 1.30, 95% CI 1.13-1.50, p=0.0002) were independently associated with the presence of postnatal anxiety and/or depressive disorders (receiver operating characteristic (ROC) = 0.7489).

CONCLUSION

Patients with greater pre-delivery neuropathic pain and higher EPDS scores at 5-9 weeks post-delivery are more likely to have postnatal depression and/or anxiety disorders, suggesting possible associations between pain and psychological vulnerability in the development of postnatal mental disorders.

Associations between Gestational Diabetes and Anxiety or Depression: A Systematic Review

Gestational diabetes mellitus (GDM) pregnant women are under more psychological stress than normal pregnant women. With the deepening of the study of gestational diabetes mellitus, research has shown that anxiety and depression are also an important cause of gestational diabetes mellitus. Anxiety and depression can cause imbalances in the hormone levels in the body, which has a serious impact on the pregnancy outcome and blood glucose control of pregnant women with GDM. Therefore, the main purpose of this paper is to provide a systematic review of the association between anxiety, depression, and GDM, as well as the adverse effects on pregnant women with GDM. To this end, we searched the PubMed, CNKI, Embase, Cochrane Library, Wanfang, and Weipu databases. Studies on the incidence of anxiety, depression, and GDM, blood glucose in pregnant women with GDM, delivery mode, and maternal and infant outcomes were included to be analyzed, and the source of anxiety and depression in pregnant women with GDM and related treatment measures were discussed.

Effects of a Brief Electronic Mindfulness-Based Intervention on Relieving Prenatal Depression and Anxiety in Hospitalized High-Risk Pregnant Women: Exploratory Pilot Study

Background

Peripartum depression and anxiety disorders are highly prevalent and are correlated with adverse maternal and neonatal outcomes. Antenatal care in Germany does not yet include structured screening and effective low-threshold treatment options for women facing peripartum depression and anxiety disorders. Mindfulness-based interventions (MBIs) are increasingly becoming a focus of interest for the management of such patients. Studies have shown a decrease in pregnancy-related stress and anxiety in expectant mothers following mindfulness programs.

Objective

The aim of this study was to explore the clinical effectiveness of a 1-week electronic course of mindfulness on prenatal depression and anxiety in hospitalized, high-risk pregnant women. We hypothesized that participating in a 1-week electronic MBI (eMBI) could alleviate symptoms of depression and anxiety during the hospital stay.

Methods

A prospective pilot study with an explorative study design was conducted from January to May 2019 in a sample of 68 women hospitalized due to high-risk pregnancies. After enrolling into the study, the participants were given access to an eMBI app on how to deal with stress, anxiety, and symptoms of depression. Psychometric parameters were assessed via electronic questionnaires comprising the Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI-S), and abridged version of the Pregnancy-Related Anxiety Questionnaire (PRAQ-R).

Results

We observed a high prevalence of peripartum depression and anxiety among hospitalized high-risk pregnant women: 39% (26/67) of the study participants in the first assessment and 41% (16/39) of the participants in the second assessment achieved EPDS scores above the cutoff value for minor/major depression. The number of participants with anxiety levels above the cutoff value (66% [45/68] of the participants in the first assessment and 67% [26/39] of the participants in the second assessment) was significantly more than that of the participants with anxiety levels below the cutoff value, as measured with the STAI-S. After completing the 1-week electronic course on mindfulness, the participants showed a significant reduction in the mean state anxiety levels (P<.03). Regarding pregnancy-related anxiety, participants who completed more than 50% of the 1-week course showed lower scores in PRAQ-R in the second assessment (P<.05). No significant changes in the EPDS scores were found after completing the intervention.

Conclusions

Peripartum anxiety and depression represent a relevant health issue in hospitalized pregnant patients. Short-term eMBIs could have the potential to reduce anxiety levels and pregnancy-related anxiety. However, we observed that compliance to eMBI seems to be related to lower symptoms of pregnancy-related stress among high-risk patients. eMBIs represent accessible mental health resources at reduced costs and can be adapted for hospitalized patients during pregnancy.

The hospital stressors and depression, anxiety levels in pregnant women hospitalized due to preterm delivery: A follow-up study

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.

Course of mental health and mother-infant bonding in hospitalized women with threatened preterm birth

PURPOSE

Pregnancy complications (PC) with signs of threatened preterm birth are often associated with lengthy hospital stays, which have been shown to be accompanied by anxiety, depressive symptoms, and increased stress level. It remains unclear, whether the perinatal course of mental health of these women differs from women without PC and whether there may be differences in the postpartum mother-infant bonding.

METHODS

In a naturalistic longitudinal study with two measurements (24-36th weeks of gestation and 6 weeks postpartum), we investigated depression (EPDS), anxiety (STAI-T), stress (PSS), and postpartum mother-infant bonding (PBQ) in women with threatened preterm birth (N = 75) and women without PC (N = 70). For data evaluation, we used means of frequency analysis, analysis of variance with repeated measurements, and t-tests for independent samples.

RESULTS

The patient group showed significantly higher rates of depression, anxiety, and stress during inpatient treatment in pregnancy, as well as 6 weeks postpartum compared to the control group. While depression and anxiety decreased over time in both groups, stress remained at the same level 6 weeks postpartum as in pregnancy. We found no significant differences in mother-infant bonding between the two groups at all considered PBQ scales.

CONCLUSION

It is recommended to pay attention to the psychological burden of all obstetric patients as a routine to capture a psychosomatic treatment indication. A general bonding problem in women with threatened preterm birth was not found. Nevertheless, increased maternal stress, anxiety, and depressiveness levels during pregnancy may have a negative impact on the development of the fetus.

Identifying trajectories of antenatal depression in women and their associations with gestational age and neonatal anthropometry: A prospective cohort study

OBJECTIVE

The present study sought to determine the longitudinal trajectories of antenatal depression and examine their associations with birth outcomes.

METHOD

926 healthy women with uncomplicated singleton pregnancies within 14 weeks of gestation participated in this prospective cohort study. Women completed a sociodemographic and medical questionnaire and the locally-validated Edinburgh Postnatal Depression Scale (EPDS) in their first, second, and third trimesters, and prior to parturition. Gestational age and neonatal weight, length, and head circumference were recorded at birth. Group-based trajectory modelling characterized trajectories of antenatal depression. Analyses of covariance and covariate-adjusted linear regressions identified associations between trajectories and neonatal outcomes.

RESULTS

Four distinct non-fluctuating trajectories of depressive symptoms were identified, with 9% women suffering from probable clinical depression throughout the pregnancy. Women in this persistently-moderate depression trajectory delivered 2.48 days earlier than in other trajectories; a one-point increase in EPDS scores was associated with an adjusted reduction of 5.82 g in birthweight.

CONCLUSIONS

Although meaningful trajectories were identified, no clinically relevant associations between persistently-moderate depressive symptoms with neonatal outcomes were found. The stability of these trajectories, however, suggests the importance of screening for depressive symptoms early in pregnancy to identify women who may benefit from greater formal and informal support.

Antenatal Anxiety: Prevalence and Patterns in a Routine Obstetric Population

Introduction: Expectant mothers may appear anxious even during healthy pregnancies. Unfortunately, little is known about antenatal anxiety, and affected women may remain undetected and untreated. This study aimed to examine the prevalence, incidence, course and associations of high state anxiety in routine obstetric care. Materials and Methods: This was an observational prospective cohort study at a large maternity unit. Obstetric outpatients with low-risk singleton pregnancies were recruited during first trimester consultations. Participants provided sociodemographic data and completed the State-Trait Anxiety Inventory (STAI) and Edinburgh Postnatal Depression Scale. The STAI was re-administered at each subsequent trimester. Results: Prevalence and incidence of  high state anxiety among 634 completers were 29.5% (95% CI 25.6%-33.6%) and 13.9% (95% CI 9.9%-18.0%), respectively. Anxiety was persistent in 17.0% (95% CI 14.3%-20.2%) and transient in 26.3% (95% CI 23.1%-29.9%). Only persistently anxious participants had high mean second trimester state anxiety scores. Odds for anxiety of greater persistence increased by 29% (95% CI 24%-35%) per 1-point increase in first trimester depression scores, and decreased by 36% (95% CI 7%-56%) with tertiary education. Conclusion: Antenatal anxiety symptoms are common even in normal pregnancies, especially among women with depression and lower education. Our study indicates value in exploring diagnostic criteria and quantitative measures for antenatal anxiety. Key words: Depression, Pregnancy, State-Trait Anxiety Inventory

Anxiety and depression during pregnancy in women attending clinics in a University Hospital in Eastern province of Saudi Arabia: prevalence and associated factors

Background

Anxiety and depression during the antenatal period is a growing problem with major effects on the mother, the developing fetus, and the neonate.

Objectives

To assess the prevalence of anxiety and depression during pregnancy in women attending the hospital for antenatal care and assess the associated factors.

Methods

This is a prospective cohort study conducted in the University Hospital of Imam Abdulrahman Bin Faisal University. Anxiety was evaluated using State Trait Anxiety Inventory. Depression was assessed using Edinburgh Postnatal Depression Scale (EPDS).

Results

Complete data were available for 575 women. The mean EPDS score was 10.5 (SD 5.5). The prevalence of depression was 26.8%. The mean state-anxiety score was 38.4 (SD 11.4) and mean trait-anxiety score was 38.2 (SD 9.5). The prevalence of anxiety using state-anxiety scale was 23.6%, while using the trait scale it was 23.9%. The risk is higher among unemployed women with history of miscarriage and unplanned pregnancy.

Conclusion

Anxiety and depression are common during pregnancy.

The prevalence and incidence of perinatal anxiety disorders among women experiencing a medically complicated pregnancy

Over 20% of pregnancies involve medical difficulties that pose some threat to the health and well-being of the mother, her developing infant, or both. We report on the first comparison of the prevalence and incidence of maternal anxiety disorders (AD) in pregnancy and the postpartum, across levels of medical risk in pregnancy. Pregnant women (N = 310) completed postnatal screening measures for anxiety. Women who scored at or above cutoff on one or more of the screening measures were administered a diagnostic interview (n = 115) for AD. Pregnancies were classified into low, moderate, or high risk based on self-report and contact with high-risk maternity clinics. The incidence of AD in pregnancy was higher among women classified as experiencing a medically moderate or high-risk pregnancy, compared with women classified as experiencing a medically low-risk pregnancy. Across risk groups, there were no differences in AD prevalence or in the incidence of AD in the postpartum. Demographic characteristics and parity did not contribute meaningfully to outcomes. Pregnancies characterized by medical risks are associated with an increased likelihood of new onset AD. Women experiencing medically complex pregnancies should be screened for anxiety and offered appropriate treatment.

Special features of high-risk pregnancies as factors in development of mental distress: a review

Introduction:

Approximately 22% of all pregnant women are classified as having high-risk pregnancies, which may involve feelings of vulnerability because of having a high-risk pregnancy, resulting in greater exposure to stressful feelings.

Objective:

To review aspects of high-risk pregnancy that can have a negative impact on the these women's mental health status.

Method:

Original articles were identified by conducting searches of the PubMed/MEDLINE, LILACS and SciELO databases, followed by a manual search of references to select articles and additional bibliographic material. Articles from the last 22 years were included in the review (1992-2014).

Results:

Fifteen articles were found that specifically studied high-risk pregnancies and mental health outcomes. Women with high-risk pregnancies exhibited a significantly higher level of stress and reported negative emotions as they dealt with stress and had worse emotional status than women with normal pregnancies. Researchers found that hospitalized pregnant women had higher levels of anxiety than non-hospitalized women. Studies of women going through normal and high-risk pregnancies show that women with normal pregnancies had good self-perceived quality of life.

Conclusion:

Special features of high-risk pregnancies could be factors in development of mental distress, in addition to psychological and social factors. Therefore, only a biopsychosocial research study would be able to identify the factors that can affect the quality of mental health during high-risk pregnancy.

The Effect of Cognitive Behavioural Therapy on Anxiety, Depression and Stress in Women with Preeclampsia

INTRODUCTION

Stress induced by preeclampsia in pregnancy may have a detrimental effect on both the mother and child. Risk of anxiety, depression and stress during pregnancy is, therefore, commonly associated with preeclampsia.

AIM

To determine the effect of Cognitive Behavioural Therapy (CBT) on anxiety, depression and stress in pregnant women with preeclampsia.

MATERIALS AND METHODS

In a clinical trial, 60 women with preeclampsia were selected by the convenience sampling method from the Imam-Ali Hospital of Amol city (North of Iran). The subjects were randomly divided into two groups; the study group (n=30) and the control (n=30). All participants completed the Hospital Anxiety and Depression Scale (HADS) and a Pregnancy Distress Questionnaire (PDQ) at the beginning and end of the study. The intervention group received 12 CBT sessions lasting for 90 minutes over 4 weeks (3 sessions in a week) and the control group received no treatment.

RESULTS

A MANCOVA test showed that CBT significantly reduced the mean scores of anxiety (5.5 ± 3.2 vs. 9.7 ± 3.8) and depression (6.4±2.6 vs 9.3±4.0) in preeclamptic women (F: 19.933, p-value <0.01). In addition, ANCOVA also revealed that CBT significantly improved the mean scores of specific-stress pregnancy (15.9 ± 6.3 vs 22.2 ± 6.8) in women with preeclampsia (F: 10.214, p-value <0.01).

CONCLUSION

Psychotherapy was effective in reducing anxiety, depression and specific-stress pregnancy in pregnant women with preeclampsia.

Factors Associated with Significant Anxiety and Depressive Symptoms in Pregnant Women with a History of Complications

Background

The occurrence of complications during the gestation period is higher among pregnant women with a history of complications than among pregnant women without previous complications. High-risk pregnancy can cause negative emotional symptoms such as anxiety and depression in pregnant women. Current research on anxiety and depression symptoms in pregnant women is sparse.

Aims

To examine the incidence of anxiety and depression symptoms in pregnant women with a history of previous complications or high risk pregnancy and related risk factors.

Methods

Women with a history of previous complications in pregnancy or current ‘high risk’ pregnancy (e.g. test tube fertilization, etc.) were classified as ‘high risk’. 197 of these ‘high risk’ women who were in their second trimester (16 to 20 weeks) underwent a monthly comprehensive assessment using the Hospital Anxiety and Depression Scale (HAD) in the last 4 months of the gestation period. The Edinburgh Postnatal Depression Scale (EPDS) was used for assessment and risk factor investigation 3 to 7 days, 42 days, and 3 months after childbirth.

Results

The mean (sd) HAD anxiety score among ‘high-risk’women at the time of enrollment was 3.69 (2.76) and depression score was 3.42 (2.53). Significant anxiety symptoms and depression symptoms were found in 14 cases (7.18 %) and 10 cases (5.13%), respectively. Multivariate analysis showed a correlation between anxiety symptoms and history of miscarriage (OR: 8.162, 95%CI: 1.213 to 54.914)and testing positive for hepatitis (OR: 8.912, 95%CI: 1.052 to 75.498). Depressive symptoms were correlated with glucose positive urine (OR: 30.529, 95%CI: 1.312 to 710.610) and history of hemorrhaging (OR: 7.122, 95%CI: 1.015 to 49.984). General factors associated with anxiety and depression symptoms include patients’ health status in the recent 3 months, concerns about fetal health, quality of marital relationship, and relationship with in-laws.

Conclusions

Anxiety and depression symptoms are commonly seen in pregnant women with a history of previous complications or current ‘high risk’ pregnancy. Patients’ recent health status, relationship with in-laws, marital quality and concerns about fetal health are associated with anxiety and depression symptoms during pregnancy.

The Influence of Gestational Diabetes on Neurodevelopment of Children in the First Two Years of Life: A Prospective Study

OBJECTIVE

Analyze the relation of gestational diabetes and maternal blood glucose levels to early cognitive functions in the first two years of life.

METHODS

In a prospective Singaporean birth cohort study, pregnant women were screened for gestational diabetes at 26-28 weeks gestation using a 75-g oral glucose tolerance test. Four hundred and seventy three children (n = 74 and n = 399 born to mothers with and without gestational diabetes respectively) underwent neurocognitive assessments at 6, 18, and/or 24 month, including electrophysiology during an attentional task and behavioral measures of attention, memory and cognition.

RESULTS

Gestational diabetes is related to left hemisphere EPmax amplitude differences (oddball versus standard) at both six (P = 0.039) and eighteen months (P = 0.039), with mean amplitudes suggesting offspring of mothers with gestational diabetes exhibit greater neuronal activity to standard stimuli and less to oddball stimuli. Associations between 2-hour maternal glucose levels and the difference in EPmax amplitude were marginal at 6 months [adjusted β = -0.19 (95% CI: -0.42 to +0.04) μV, P = 0.100] and significant at 18 months [adjusted β = -0.27 (95% CI: -0.49 to -0.06) μV, P = 0.014], and the EPmax amplitude difference (oddball-standard) associated with the Bayley Scales of Infant and toddler Development-III cognitive score at 24 months [β = 0.598 (95% CI: 0.158 to 1.038), P = 0.008].

CONCLUSION

Gestational diabetes and maternal blood glucose levels are associated with offspring neuronal activity during an attentional task at both six and eighteen months. Such electrophysiological differences are likely functionally important, having been previously linked to attention problems later in life.

Prevalence of antenatal depression and associated factors among pregnant women hospitalized in a high-risk pregnancy unit in Greece

PURPOSE

Women who face pregnancy complications may require hospitalization in a high-risk pregnancy unit (HRPU), and this may have a negative impact on the pregnant woman's mental health. The purpose of this study was to screen for depressive symptoms in pregnant women admitted in a high-risk pregnancy unit and also to investigate associated risk factors.

METHODS

This was a cross-sectional study that enrolled pregnant women admitted at ≥24 gestational weeks in a university hospital HRPU, between September 2014 and November 2015. The Edinburgh Postnatal Depression Scale was used to assess depressive symptoms on admission. A cutoff score ≥13 was considered as indicative of depression. Test results were then correlated with the reasons that led to the women's admission as well as socio-demographic characteristics.

RESULTS

Overall, 157 of the women admitted in the HRPU during the study period were eligible for the study and agreed to complete the questionnaire. The mean age of the pregnant women was 30 ± 6 years, and the mean gestational week at admission was 32 ± 3 weeks. The prevalence of antenatal depression (score ≥13) was 28 % (44/157). In the multivariate analysis, antenatal depression was significantly correlated with smoking (OR = 2.681, 95 % CI 1.089-6.601) and the existence of thoughts for pregnancy termination (OR = 3.624, 95 % CI 1.149-11.427).

CONCLUSIONS

Approximately one quarter of pregnant women hospitalized in the HRPU may show signs of depression at the time of admission. Smoking and an unwanted pregnancy were found to be independently associated with antenatal depression, whereas no association was found with any obstetric parameters.

Patterns and predictors of treatment outcome for antenatal major depression

INTRODUCTION

Antenatal major depression is a relatively common and potentially debilitating illness, but knowledge of its treatment outcomes and strategies is still lacking. This study aimed to explore the clinical profiles and treatment outcomes of patients with antenatal major depression, to look for patterns and associations that could guide subsequent research and clinical applications.

METHODS

From May 2006 to November 2010, 118 consecutive patients with antenatal major depression were naturalistically assessed over eight months of individualised therapy, and their characteristics were assessed as potential predictors of treatment outcome.

RESULTS

All participants accepted supportive counselling and case management, although only 51 (43.2%) participants accepted low-dose antidepressant therapy. Overall, 95 (80.5%) of them were successfully discharged, while 12 (10.2%) required extended treatment into the postnatal period. An equation for prognosticating the need for extended treatment was obtained using multiple logistic regression analysis, which incorporated three predictors: previous depression (odds ratio [OR] 12.4, 95% confidence interval [CI] 1.40-110; p = 0.024); maternal age < 26 years or > 35 years (OR 6.88, 95% CI 1.67-28.4; p = 0.008); and no use of antidepressant (OR 6.94, 95% CI 0.79-60.9; p = 0.080). Among participants with previous depression and at either extreme of maternal age, the number needed to treat with antidepressants to avert extended treatment was three.

CONCLUSION

The majority of women with antenatal major depression recovered after receiving short-term treatment. Those with previous depression and who were of relative extreme maternal age were most likely to benefit from antidepressant treatment to expedite recovery.

Prevalence and Risk Factors of Maternal Anxiety in Late Pregnancy in China

Objective: A large number of studies have shown the adverse neonatal outcomes of maternal psychological ill health. Given the potentially high prevalence of antenatal anxiety and few studies performed among Chinese people, the authors wanted to investigate the prevalence of antenatal anxiety and associated factors among pregnant women and to provide scientific basis to reduce prenatal anxiety effectively. Methods: A cross-sectional study was carried out at the Changchun Gynecology and Obstetrics Hospital from January 2015 to march 2015, with 467 participants of at least 38 weeks’ gestation enrolled. Antenatal anxiety was measured using the Self-Rating Anxiety Scale (SAS). χ² test and logistic regression analysis were performed to evaluate the association of related factors of antenatal anxiety. Results: Among the 467 participants, the prevalence of antenatal anxiety was 20.6% (96 of 467). After adjustment for women’s socio-demographic characteristics (e.g., area, age, household income), multivariate logistical regression analysis revealed that antenatal anxiety showed significant relationship with education level lower than middle school (years ≤ 9), expected natural delivery, anemia during pregnancy, pregnancy-induced hypertension syndrome, disharmony in family relationship and life satisfaction. Conclusions: It is important to prevent or reduce antenatal anxiety from occurring by improving the health status of pregnant women and strengthening prenatal-related education and mental intervention.

Retrospective observation of mental disorders during postpartum period: Results from the Singapore mental health study

Background

The perinatal period has been identified as a period of vulnerability for various disorders (particularly anxiety and depressive disorders), which have been associated with negative outcomes for both mother and infant. The current study utilized data from the Singapore Mental Health Study (SMHS) to examine the temporal relationship between mental disorders and the perinatal period, as well as associated risk factors.

Methods

Life table estimation method was used to derive the estimated hazard rate for any mood or anxiety disorders following pregnancy. Multivariate logistic regression was used to examine the association between socio-demographic factors and onset of mental disorders after the first pregnancy.

Results

Among women with children (n = 2278), 1.5 % were found to have an onset of any mental disorder (i.e., mood disorders, anxiety disorders, alcohol use disorders), within 2 years after pregnancy. A peak in hazard rate was noted at approximately 1 year following pregnancy for anxiety disorders but not mood disorders. Women who were married, employed and physically healthy were less likely to have had developed any mental disorder.

Conclusions

The prevalence of mental disorders during pregnancy and postpartum was found to be low among women with children in our community sample, with increased vulnerability following delivery. The results offer some insight into the occurrence of mental disorders during the perinatal period among women in Singapore.

Validation of the High-Risk Pregnancy Stress Scale in a sample of hospitalized Greek high-risk pregnant women

The aim of the authors in this study was to determine the psychometric properties of the Greek adaptation of the High-Risk Pregnancy Stress Scale (HRPSS) in a sample of high-risk hospitalized pregnant women. The sample consisted of 133 high-risk pregnant women with gestational age from 9 to 37 weeks. Data were collected between February and June of 2014. HRPSS was "forward-backward" translated from English to Greek. Principal axis factoring with promax rotation was used to test the factor structure of the HRPSS. Measures of state anxiety (STAI) and depressive symptoms (EPDS) were used to assess the convergent validity of the HRPSS. Exploratory factor analysis suggested three factors: concerns of pregnancy, movement restriction, and isolation and restriction of external activities. Construct validity was confirmed by computing correlations between the HRPSS and constructions of anxiety and depressive symptoms. Internal consistency reliability was satisfactory (α = 0.813). The original factor structure of the HRPSS was only partly replicated. The results of the exploratory factor analysis suggested that a three-factor solution instead of a two-factor solution would be the most adequate. The HRPSS is an appropriate measure for assessing the levels of concerns regarding pregnancy outcome, movement restriction, isolation, and external activity restrictions in Greek high-risk pregnant women.

Personality, preterm labor contractions, and psychological consequences

PURPOSE

Research of psychological factors associated with imminent preterm labor (PTL) is sparse, compared with considerable research of preterm birth. We explored state and trait psychological variables associated with PTL, both pre- and postpartum.

METHODS

During 2012-2014, 56 women hospitalized due to PTL, and 33 pregnant women without PTL, responded during gestational week 20-33, to a demographic questionnaire, the Big-Five Inventory (BFI), the Brief Symptom Inventory (BSI), the Fear of Childbirth Questionnaire, and the Maternal-Fetal Attachment Inventory (MFAS). At 4-6 weeks postpartum, 35 and 23 of the women in the respective groups responded online to the Edinburgh Postnatal Depression Scale (EPDS) and the Mother to Infant Bonding Scale (MIBS).

RESULTS

Compared to women without PTL, women with PTL scored higher on neuroticism, openness to experience, and MFAS (p < 0.01 each), scored lower on consciousness and agreeableness (p < 0.01 each), and showed greater fear of childbirth (p < 0.05). Significant differences were not found in the postpartum variables of EPDS and MIBS. In the PTL group, MFAS (β = 0.36, p < 0.01), but not fear of childbirth (β = 0.08, p = NS), remained higher, after controlling for demographic variables and neuroticism.

CONCLUSIONS

PTL was associated with personality variables, but not with psychological consequences, other than elevated prepartum attachment to the fetus.

Depression and anxiety in pregnancy and postpartum in women with mild and severe preeclampsia

BACKGROUND

Risk for anxiety and depression is increased in women with high-risk pregnancy. The aim of this study was to evaluate anxiety and depression in women with mild and severe preeclampsia at admission and 6 weeks postpartum.

MATERIALS AND METHODS

In this cohort study, 122 preeclamptic women who were admitted to the Public hospital and Tamin Ejtemaee hospital of Mashhad were included. Selection was done by convenience sampling method. Beck Depression Inventory II (BDI-II) and Spielberger State-Trait Anxiety Inventory (STAI) were completed at admission and 6 weeks after delivery. Data were analyzed by SPSS 16 using Chi-square, Fisher's exact test, Mann-Whitney U test, and Repeated measurement.

RESULTS

The mean depression score was 4.81 ± 4.09 at admission and 11.17 ± 5.5 at 6 weeks postpartum. The mean of trait anxiety was 42.5 ± 10.5 at admission and 32.3 ± 6.5 at 6 weeks postpartum, and the mean of state anxiety score at admission was 43.09 ± 9.5 and at 6 weeks postpartum was 31.99 ± 5.9. There was a significant difference between the scores of depression (F = 3.8, P < 0.001), state anxiety (F = 1.52, P < 0.001), and trait anxiety (F = 1.5, P < 0.001) at admission and 6 weeks postpartum. No significant differences were found between severity of preeclampsia and the scores of depression, state anxiety, and trait anxiety at admission and 6 weeks postpartum.

CONCLUSIONS

The mean score of state and trait anxiety decreased significantly in preeclamptic women from admission to 6 weeks postpartum, but the mean score of depression increased. Severity of preeclampsia was not an independent risk factor of depression and anxiety.

Predictors of anxiety among pregnant New Zealand women hospitalised for complications and a community comparison group

OBJECTIVE

to investigate predictors of anxiety for women experiencing hospitalisation during pregnancy and a comparison group of pregnant women (with or without medical complications) in the community.

DESIGN

correlational, cross-sectional observational questionnaire study.

SETTING

regional antenatal inpatient unit and community-based settings in New Zealand in 2009 and 2010.

PARTICIPANTS

118 pregnant women in hospital and 114 pregnant women in community.

MEASUREMENTS AND FINDINGS

women in hospital and community groups completed a battery of questionnaires on pregnancy and health history, life events, anxiety, optimism, coping, and relationship factors. Midwives caring for the women provided ratings of health status and psychological distress. Both groups of women had scores on state anxiety significantly above local norms; women in the hospital were significantly higher than those in the community on state anxiety and worry about their pregnancy. The groups did not differ on factors such as life events, optimism, and coping self-efficacy. Ratings of health and distress made by women and their midwives showed poor agreement. Predictors of acute anxiety differed across the groups: for hospitalised women, anxiety was predicted by their rating of their health and their dispositional optimism; for women in the community, anxiety was predicted by stressful life events, dispositional optimism, and coping self-efficacy.

KEY CONCLUSIONS

many women hospitalised during pregnancy are extremely anxious, and those most vulnerable are those who are less optimistic and see their health as poor. Health care professionals may not be aware of how anxious women are, and women and their hospital caregivers had poor agreement on ratings of the woman׳s health status.

IMPLICATIONS FOR RESEARCH AND PRACTICE

women hospitalised during pregnancy are at risk for high levels of anxiety. Midwives are well placed to help women by recognising their distress, supporting informed optimism, and guiding women toward realistic coping strategies and using existing social support networks. Research is needed on strategies for implementation and effectiveness of brief interventions to support women to manage anxiety and stress during pregnancy both in hospital and in the community.