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Dalmijn EW, Visse MA, van Nistelrooij I. Decision-making in case of an unintended pregnancy: an overview of what is known about this complex process. J Psychosom Obstet Gynaecol 2024; 45:2321461. [PMID: 38469857 DOI: 10.1080/0167482x.2024.2321461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/16/2024] [Indexed: 03/13/2024] Open
Abstract
Introduction: Unintended pregnancies are a worldwide health issue, faced each year by one in 16 people, and experienced in various ways. In this study we focus on unintended pregnancies that are, at some point, experienced as unwanted because they present the pregnant person with a decision to continue or terminate the pregnancy. The aim of this study is to learn more about the decision-making process, as there is a lack of insights into how people with an unintended pregnancy reach a decision. This is caused by 1) assumptions of rationality in reproductive autonomy and decision-making, 2) the focus on pregnancy outcomes, e.g. decision-certainty and reasons and, 3) the focus on abortion in existing research, excluding 40% of people with an unintended pregnancy who continue the pregnancy. Method: We conducted a narrative literature review to examine what is known about the decision-making process and aim to provide a deeper understanding of how persons with unintended pregnancy come to a decision.Results: Our analysis demonstrates that the decision-making process regarding unintended pregnancy consists of navigating entangled layers, rather than weighing separable elements or factors. The layers that are navigated are both internal and external to the person, in which a 'sense of knowing' is essential in the decision-making process. Conclusion: The layers involved and complexity of the decision-making regarding unintended pregnancy show that a rational decision-making frame is inadequate and a more holistic frame is needed to capture this dynamic and personal experience.
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Affiliation(s)
- Eline W Dalmijn
- Faculty of Philosophy, Theology and Religious Studies, Radboud University, Nijmegen, The Netherlands
- Fiom, Centre of Expertise in Unwanted Pregnancy and Ancestry, 's-Hertogenbosch, The Netherlands
| | - Merel A Visse
- Caspersen School of Graduate Studies, Medical and Health Humanities, Drew University, Madison, Wisconsin, USA
| | - Inge van Nistelrooij
- Care Ethics and Policy, University of Humanistic Studies, Utrecht, The Netherlands
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2
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Kremer S, Gerlach AL, Erbe D. Depression, Contraception, and Ambivalence Concerning Fertility. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2727-2736. [PMID: 38831232 PMCID: PMC11219453 DOI: 10.1007/s10508-024-02879-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/08/2024] [Accepted: 04/22/2024] [Indexed: 06/05/2024]
Abstract
Individuals suffering from depression exhibit a higher rate of unintended pregnancies, which are associated with negative outcomes for both parents and children. Often, unintended pregnancies result from contraceptive mistakes. Here, we examine the relationship between depression and the consistency of contraceptive behavior, testing ambivalence as a possible mediator. The analyses were based on cross-sectional data from the second and third waves of the German Relationship and Family Panel Pairfam. A German-speaking sample without children (N = 190; 117 female, 73 male), who reported not attempting to conceive or become pregnant during the last 12 months, was analyzed in comparison with a propensity score matched sample. Ambivalence was operationalized as the difference between the ideal and realistic number of children in wave 2. Data from wave 3 were used to assess contraceptive behavior. Depressed mood in wave 2 and consistency of contraceptive behavior in wave 3 were negatively correlated. After including ambivalence in wave 2 as a mediator in the model, the direct path between depressed mood and consistency of contraceptive behavior remained significant, with no significant mediation found. For men only, we observed a significant negative association of ambivalence with the consistency of contraceptive behavior in the last 3 months. No significant relationship was found between depressed mood and ambivalence. We conclude that future research aiming to better understand the consistency of contraceptive behavior should incorporate measures of ambivalence.
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Affiliation(s)
- Sina Kremer
- Department of Psychology, University of Cologne, Pohligstr. 1, 50969, Cologne, Germany
| | - Alexander L Gerlach
- Department of Psychology, University of Cologne, Pohligstr. 1, 50969, Cologne, Germany
| | - Doris Erbe
- Department of Psychology, University of Cologne, Pohligstr. 1, 50969, Cologne, Germany.
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3
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Schonewille NN, van den Eijnden MJM, Sahin R, Jonkman NH, van Kempen AAMW, van Pampus MG, Scheele F, van den Heuvel OA, Broekman BFP. The conversation about family planning and desire for children in mental healthcare: Patients' perspective versus Professionals' perspective in a mixed methods study. Acta Psychiatr Scand 2024. [PMID: 38922817 DOI: 10.1111/acps.13725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 11/11/2023] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Reproductive health and mental health are intertwined, but studies investigating family planning needs and desire for children in mental healthcare are scarce. METHODS We studied the experiences of (former) patients, those with close relationships with the (former) patients (close ones) and mental health professionals (MHP) on discussing family planning and desire for children in mental healthcare. We combined quantitative (two nationwide surveys) and qualitative data (four focus groups) in a mixed-methods approach with sequential analytical design. RESULTS Combined data from focus groups (n = 19 participants) and two surveys (n = 139 MHPs and n = 294 (former) patients and close ones) showed that a considerable group of MHPs (64.0%), patients (40.9%) and close ones (50.0%) found that family planning should be discussed by a psychiatrist. However, several obstacles impeded a conversation, such as fear of judgment, lack of time and knowledge and limited opportunity for in-depth exploration of life themes in therapeutic relationships. CONCLUSIONS To increase the autonomy of patients in discussing family planning, we suggest MHPs explore the desire to discuss family planning with all patients in the reproductive phase of life, prior to discussing contraceptive care. MHPs should receive education about psychiatric vulnerability in relation to family planning and desire for children, and patients and close ones should be empowered to initiate a conversation themselves.
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Affiliation(s)
- Noralie N Schonewille
- Department of Psychiatry and Medical Psychology, OLVG, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
| | - Monique J M van den Eijnden
- Department of Psychiatry and Medical Psychology, OLVG, Amsterdam, The Netherlands
- Team Knowledge, Innovation and Research, MIND, Amersfoort, The Netherlands
| | - Ruveyda Sahin
- Department of Psychiatry and Medical Psychology, OLVG, Amsterdam, The Netherlands
| | - Nini H Jonkman
- Department of Research and Epidemiology, OLVG, Amsterdam, The Netherlands
| | | | - Maria G van Pampus
- Department of Gynecology and Obstetrics, OLVG, Amsterdam, The Netherlands
| | - Fedde Scheele
- Department of Gynecology and Obstetrics, OLVG, Amsterdam, The Netherlands
| | - Odile A van den Heuvel
- Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Anatomy & Neuroscience, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention program, Amsterdam, The Netherlands
| | - Birit F P Broekman
- Department of Psychiatry and Medical Psychology, OLVG, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
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Maghalian M, Nikanfar R, Nabighadim M, Mirghafourvand M. Comparison of maternal-fetal attachment, anxiety, depression, and prevalence of intimate partner violence in Iranian women with intended and unintended pregnancy: a cross-sectional study. BMC Psychol 2024; 12:345. [PMID: 38867327 PMCID: PMC11170898 DOI: 10.1186/s40359-024-01847-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 06/10/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Unintended pregnancies and intimate partner violence can adversely affect women, infants, and their psychological well-being. The study aimed to compare depression, anxiety, maternal-fetal attachment, and the prevalence of intimate partner violence between women with and without unintended pregnancies in Tabriz, Iran. The study sought to address the lack of research on this topic in the Iranian context. METHODS This cross-sectional study was conducted on 486 pregnant women attending health centers in Tabriz City between 2022 and 2023. A cluster sampling method was utilized, and data were gathered through the administration of socio-demographic, Maternal Fetal Attachment, Edinburgh Postnatal Depression, World Health Organization Domestic Violence, and Pregnancy Anxiety instruments. A general linear model (GLM), controlling for potential confounding variables, was used to compare anxiety, depression, and maternal-fetal attachment between the two groups. Multivariable logistic regression analysis, also controlling for potential confounding variables, was employed to compare the prevalence of domestic violence between the two groups. RESULTS The results of the adjusted GLM indicated that women with unintended pregnancies had significantly lower maternal-fetal attachment (Adjusted mean difference (AMD):-9.82, 95% CI:-12.4 to -7.15 ; p < 0.001)), higher levels of depression (AMD: 2.89; CI: 1.92 to 3.86 ; p < 0.001), and higher levels of anxiety (MD: 5.65; 95% CI: 3.84 to 7.45; p < 0.001) compared to women with intended pregnancies. During pregnancy, 40% of women with unintended pregnancies and 19.2% of women with intended pregnancies reported experiencing at least one form of physical, sexual, or emotional violence. The results of the adjusted multivariable logistic regression revealed that women with unintended pregnancies had a significantly higher odds of experiencing emotional violence (adjusted odds ratio [aOR]: 2.94; 95% CI: 1.64 to 5.26; p < 0.001), sexual violence, (aOR: 2.25; 95% CI: 1.32 to 3.85; p = 0.004), and physical violence (aOR: 2.38; 95% CI: 1.50 to 3.77; p < 0.001) compared to women with intended pregnancies. CONCLUSIONS The study found that women with unintended pregnancies had lower levels of maternal-fetal attachment, higher levels of anxiety and depression, and a high prevalence of intimate partner violence, including physical, sexual, and emotional violence, compared to women with intended pregnancies. These results emphasize the importance of implementing policies aimed at reducing unintended pregnancies.
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Affiliation(s)
- Mahsa Maghalian
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mahsan Nabighadim
- Medical School, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Enthoven CA, Labrecque JA, Koopman-Verhoeff ME, Lambregtse-van den Berg MP, Hillegers MHJ, Marroun HE, Jansen PW. Reducing behavior problems in children born after an unintended pregnancy: the generation R study. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02693-3. [PMID: 38819520 DOI: 10.1007/s00127-024-02693-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 05/17/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVES To examine differences in behavior problems between children from intended versus unintended pregnancies, and to estimate how much the difference in problem behavior would be reduced if postnatal depression was eliminated and social support was increased within 6 months after birth. METHODS Data from the Generation R Study were used, a population-based birth cohort in Rotterdam, the Netherlands (N = 9621). Differences in child internalizing and externalizing behavior at ages 1.5, 3, 6, 9 and 13 years between pregnancy intention groups were estimated using linear regression. Associations of postnatal depression and social support with internalizing and externalizing problems were also estimated using linear regression. Child behavior outcomes where compared before and after modelling a situation in which none of the mothers experienced a postnatal depression and all mother experienced high social support. RESULTS Most pregnancies (72.9%) were planned, 14.8% were unplanned and wanted, 10.8% were unplanned with initially ambivalent feelings and 1.5% with prolonged ambivalent feelings. Children from unplanned pregnancies had more internalizing and externalizing problems at all ages as compared to children from a planned pregnancy, especially when ambivalent feelings were present. Hypothetically eliminating on postnatal depression reduced the differences in internalizing and externalizing problems by 0.02 to 0.16 standard deviation. Hypothetically increasing social support did not significantly reduce the difference in internalizing and externalizing problems. CONCLUSIONS Children from an unplanned pregnancy have more behavior problems, in particular when mothers had prolonged ambivalent feelings. Eliminating postnatal depression may help to reduce the inequality in child behavior related to pregnancy intention.
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Affiliation(s)
- Clair A Enthoven
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioral Sciences, Erasmus University, Mandeville Building, Floor T13, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center-Sophia Childrens Hospital, Rotterdam, The Netherlands
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jeremy A Labrecque
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Elisabeth Koopman-Verhoeff
- Simches Division of Child and Adolescent Psychiatry, McLean Hospital and Harvard Medical School, Belmont, MA, USA
| | - Mijke P Lambregtse-van den Berg
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center-Sophia Childrens Hospital, Rotterdam, The Netherlands
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center-Sophia Childrens Hospital, Rotterdam, The Netherlands
| | - Hanan El Marroun
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioral Sciences, Erasmus University, Mandeville Building, Floor T13, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center-Sophia Childrens Hospital, Rotterdam, The Netherlands
| | - Pauline W Jansen
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioral Sciences, Erasmus University, Mandeville Building, Floor T13, Rotterdam, The Netherlands.
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center-Sophia Childrens Hospital, Rotterdam, The Netherlands.
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Cheney K, Mignacca E, Black KI, Homer C, Bradfield Z. An exploration of the contraceptive counselling practices of midwives who provide postpartum care in Australia. Midwifery 2024; 131:103948. [PMID: 38335692 DOI: 10.1016/j.midw.2024.103948] [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: 06/03/2023] [Revised: 12/13/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE We sought to explore and describe midwives' attitudes and practices relating to their provision of postpartum contraception counselling. DESIGN We used an exploratory cross-sectional design. Recruitment used an anonymous online survey using electronic communication platforms of professional, and special-interest organisations, over six months . Descriptive and quantitative analysis was used. SETTING AND PARTICIPANTS Australian Midwives who provide postpartum care. MEANING AND FINDINGS A total of 289 complete responses were included. Findings from this national survey of midwives showed that almost 75% of Australian midwives reported providing some contraceptive advice to women. Those working in continuity of care models were significantly more likely to fulfil this responsibility. More than half (67%) indicated they had not received any formal contraception education or training. Those working in private obstetric-led settings were significantly less likely to have received education compared to midwives in community settings. Systems barriers preventing the provision of contraceptive counselling included: clinical workload; lack of management support; lack of education; and models of care. KEY CONCLUSIONS Most midwives (82%) wanted to provide postpartum contraception counselling as part of their role. They cited barriers from within the health system, ambiguity about roles and responsibilities and offered solutions to improve the provision of postnatal contraception counselling. IMPLICATIONS FOR PRACTICE Recommendations include the development of education programs for midwives. Continuity of care models provided the time, autonomy and opportunity for midwives to undertake contraceptive counselling and fulfil this part of their professional scope. Consideration should be given to expanding access and provision of continuity of midwifery care. An urgent investment in the education and skills of midwives is recommended to ensure all women across acute and community services benefit from improved outcomes associated with pregnancy spacing.
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Affiliation(s)
- Kate Cheney
- The Sydney School of Nursing and Midwifery, Faculty of Medicine and Health, Susan Wakil Health Building, The University of Sydney, NSW 2006, Australia.
| | - Emily Mignacca
- School of Nursing, Midwifery, Oral Health Therapy, Paramedicine, Faculty of Health Science, Curtin University Perth, WA 6102, Australia
| | - Kirsten I Black
- The Sydney Medical School, Faculty of Medicine and Health, Susan Wakil Health Building, The University of Sydney, NSW 2006, Australia
| | - Caroline Homer
- Maternal, Child and Adolescent Health, Burnet Institute, Melbourne 3004, Australia
| | - Zoe Bradfield
- School of Nursing, Midwifery, Oral Health Therapy, Paramedicine, Faculty of Health Science, Curtin University Perth, WA 6102, Australia
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McKetta S, Chakraborty P, Gimbrone C, Soled KRS, Hoatson T, Beccia AL, Reynolds CA, Huang AK, Charlton BM. Restrictive abortion legislation and adverse mental health during pregnancy and postpartum. Ann Epidemiol 2024; 92:47-54. [PMID: 38432536 PMCID: PMC10983835 DOI: 10.1016/j.annepidem.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 02/06/2024] [Accepted: 02/27/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To determine the impact of abortion legislation on mental health during pregnancy and postpartum and assess whether pregnancy intention mediates associations. METHODS We quantified associations between restrictive abortion laws and stress, depression symptoms during and after pregnancy, and depression diagnoses after pregnancy using longitudinal data from Nurses' Health Study 3 in 2010-2017 (4091 participants, 4988 pregnancies) using structural equation models with repeated measures, controlling for sociodemographics, prior depression, state economic and sociopolitical measures (unemployment rate, gender wage gap, Gini index, percentage of state legislatures who are women, Democratic governor). RESULTS Restrictive abortion legislation was associated with unintended pregnancies (β = 0.127, p = 0.02). These were, in turn, associated with increased risks of stress and depression symptoms during pregnancy (total indirect effects β = 0.035, p = 0.03; β = 0.029, p = 0.03, respectively, corresponding <1% increase in probability), but not after pregnancy. CONCLUSIONS Abortion restrictions are associated with higher proportions of unintended pregnancies, which are associated with increased risks of stress and depression during pregnancy.
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Affiliation(s)
- Sarah McKetta
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, United States.
| | - Payal Chakraborty
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, United States
| | - Catherine Gimbrone
- Department of Epidemiology, Columbia University Mailman School of Public Health, United States
| | - Kodiak R S Soled
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States
| | - Tabor Hoatson
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States
| | - Ariel L Beccia
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, United States
| | - Colleen A Reynolds
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, United States
| | - Aimee K Huang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, United States
| | - Brittany M Charlton
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, United States; Department of Pediatrics, Harvard Medical School, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, United States
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8
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McNamara KA, Murnion B, Fotheringham P, Terplan M, Lintzeris N, Oei JL, Bond DM, Nassar N, Black KI. Interconnections between unintended pregnancy, alcohol and other drug use, and pregnancy, birth, infant, childhood and socioeconomic outcomes: a scoping review. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024:bmjsrh-2023-202140. [PMID: 38471787 DOI: 10.1136/bmjsrh-2023-202140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/29/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Unintended pregnancy (UIP) and substance use disorder share underlying root causes with similar impacts for women and their offspring in pregnancy, birth and beyond. Furthermore, intoxication with alcohol and other drugs (AOD) increases the risk of UIP. OBJECTIVES To assess the available evidence on associations between UIP and health, social and economic outcomes, in women who use AOD. SEARCH STRATEGY The review utilised the Joanna Briggs Institute Methodology for Scoping Reviews and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. The search was conducted across multiple databases, including Scopus and Medline, and limited to studies published between January 2000 to June 2023. SELECTION CRITERIA Studies reporting on interactions between AOD use and UIP, and pregnancy, birth, infant, childhood, social or economic outcomes. All patterns and types of AOD use, except isolated use of tobacco, were included. Studies were available in English and conducted in high-income countries. DATA COLLECTION AND ANALYSIS Selected articles were reviewed, and data collected by two independent reviewers using a standardised data extraction sheet. Findings were summarised and reported descriptively. MAIN RESULTS A total of 2536 titles and abstracts were screened, 97 full texts were reviewed, and three studies were selected for inclusion in the scoping review. There was heterogeneity in types and patterns of AOD use, differences in study design and tools to assess pregnancy intention, and each focused on disparate outcomes. No study assessed or reported on birth outcomes. CONCLUSION There is a paucity of data examining the intersection between AOD use and UIP and further research is needed.
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Affiliation(s)
- Kelly A McNamara
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Bridin Murnion
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Penelope Fotheringham
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- MotherSafe Counselling Service, The Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Mishka Terplan
- Friends Research Institute Inc, Baltimore, Maryland, USA
| | - Nicholas Lintzeris
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Kogarah, New South Wales, Australia
| | - Ju Lee Oei
- Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Newborn Care, The Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Diana M Bond
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten I Black
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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9
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Schonewille NN, Jonkman NH, van Kempen AAMW, van Pampus MG, van den Heuvel OA, Broekman BFP. Pregnancy intention in relation to maternal and neonatal outcomes in women with versus without psychiatric diagnoses. Acta Psychiatr Scand 2024; 149:110-123. [PMID: 37933529 DOI: 10.1111/acps.13625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/04/2023] [Accepted: 10/08/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Studies have identified adverse maternal and neonatal outcomes for women with psychiatric disorders. Additionally, psychiatric disorders may pose an increased risk for unintended pregnancies (UPs) which in turn may also impact negatively on outcomes. The present study aims to compare the incidence of UPs in women with versus without current/past psychiatric diagnoses and investigates whether psychiatric history modifies the relation between delivery outcomes in women with and without UPs. METHODS A retrospective cohort was compiled of women who gave birth in a large hospital in Amsterdam, the Netherlands. Women ≥18 years old with singleton pregnancies and birth registrations in the electronic patient file during January 1, 2015 to March 1, 2020 were included. Patient characteristics (including pregnancy intention and psychiatric history), maternal (gestational diabetes, mode of delivery) and neonatal outcomes (e.g., gestational age [GA], birthweight and Apgar scores) were registered by health care providers in hospital charts. Incidence of UPs was compared between women with versus without current/past psychiatric diagnoses. Maternal and neonatal outcomes were compared between women with versus without UPs with linear or logistic regression models adjusted for relevant confounders with an interaction term for UP with current/past psychiatric diagnoses. RESULTS We included 1219 women with and 1093 women without current/past psychiatric diagnoses. Current/past psychiatric diagnoses were significantly associated with UPs after adjustment for confounders (39.0% vs. 29.6%, OR 1.56, CI 1.23-2.00, p < 0.001). In sub-analyses, women with depressive (OR 1.67, CI 1.24-2.26, p = 0.001), personality (OR 2.64, CI 1.38-5.11, p = 0.004) and substance-related and addictive disorders (OR 4.29, CI 1.90-10.03, p = 0.001) had higher odds of UPs compared to women without current/past psychiatric diagnoses. Amongst women with UPs, current/past psychiatric diagnoses did not modify maternal or neonatal outcomes, except for GA at delivery as women with both UPs and current/past psychiatric diagnosis had a 2.21-day higher mean GA at delivery than women in the reference group (p-value interaction = 0.001). CONCLUSIONS Current/past psychiatric diagnoses are associated with a higher odd of UPs. In our sample, maternal and neonatal outcomes were comparable for women with and without UPs and these results were similar for women with and without current/past psychiatric diagnoses, except for GA at delivery. Although our study is limited by several factors, we found that women with current/past psychiatric diagnoses, irrespective of pregnancy planning status, do not have more adverse maternal or pregnancy outcomes. Increased efforts are needed to ensure that psychoeducation and conversations about pregnancy planning and UPs are available for women with current/past psychiatric diagnoses.
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Affiliation(s)
- Noralie N Schonewille
- Department of Psychiatry and Medical Psychology, OLVG, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Mental Health Program, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Nini H Jonkman
- Department of Research and Epidemiology, OLVG, Amsterdam, The Netherlands
| | | | - Maria G van Pampus
- Department of Gynaecology and Obstetrics, OLVG, Amsterdam, The Netherlands
| | - Odile A van den Heuvel
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Anatomy & Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Compulsivity, Impulsivity & Attention Program, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Birit F P Broekman
- Department of Psychiatry and Medical Psychology, OLVG, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Mental Health Program, Amsterdam Public Health, Amsterdam, The Netherlands
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10
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Chen Q, Liu XL, Lin LZ, Wang X, Li MH, Dai MX, Cao MQ, Li XH, Jin J, Xu HQ, Cai L. Associations of unintended pregnancy with autism spectrum disorders and the modification of folic acid supplements. Autism Res 2024; 17:172-181. [PMID: 38131613 DOI: 10.1002/aur.3070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 11/12/2023] [Indexed: 12/23/2023]
Abstract
There is limited evidence on the associations of unintended pregnancy with autism spectrum disorders (ASD). This study aimed to examine this relationship and the modification of pre-conceptional and prenatal folic acid supplements. Six thousand and five toddlers aged 16 to 30 months from seven cities of six provinces in China were eligible for participation. Information on unintended pregnancy and folic acid supplements was obtained via questionnaires from caregivers of toddlers. The diagnosis of ASD was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the Chinese version of the Childhood Autism Rating Scale (CARS). Of the 6005 toddlers in the study (3337 boys and 2668 girls), 71 (1.18%) received the diagnosis of ASD. Generalized linear models with a logit link function showed unintended pregnancy was positively associated with ASD (odds ratios [OR] = 1.69, 95% confidence interval [CI], 1.05-2.79). Stratified estimates indicated that the association remained stable among toddlers of mothers without pre-conceptional and prenatal folic acid supplements (OR = 2.75, 95% CI, 1.04-7.27; n = 1243, 20.70%). Unintended pregnancy was associated with higher odds of ASD in 16-30 months of toddlers, and the association was consistent among toddlers of mothers without prenatal folic acid supplements. Our findings emphasize the need to raise awareness of the risk of unintended pregnancy and the benefits of folic acid supplements among Chinese women.
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Affiliation(s)
- Qian Chen
- Department of Neonatology, Guangzhou Key Laboratory of Neonatal Intestinal Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Xing-Lian Liu
- Department of Child Health Care, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, People's Republic of China
| | - Li-Zi Lin
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Xin Wang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Ming-Hui Li
- Department of Child Health Care, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, People's Republic of China
| | - Mei-Xia Dai
- Department of Children's Healthcare and Mental Health Center, Shenzhen Children's Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Mu-Qing Cao
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Xiu-Hong Li
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Jing Jin
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Hai-Qing Xu
- Department of Child Health Care, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, People's Republic of China
| | - Li Cai
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
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11
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Dijkstra CI, Dalmijn EW, Bolt SH, Groenhof F, Peters LL, Jansen DEMC. Women with unwanted pregnancies, their psychosocial problems, and contraceptive use in primary care in Northern Netherlands: insights from a primary care registry database. Fam Pract 2023; 40:648-654. [PMID: 37029597 DOI: 10.1093/fampra/cmad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
INTRODUCTION Globally an estimated 1 in 16 women per year experience an unwanted pregnancy (UWP). In the Netherlands, general practitioners (GPs) play an important role in providing care for women with UWP; however, it is unknown how many of these women consult their GP about the pregnancy. UWPs are a major life experience with a possible influence on mental health. Data that GPs register about UWPs, psychosocial problems, and contraceptive use could give more insight into care needs. AIMS To create an overview of (i) the prevalence of UWPs in general practice, (ii) the prevalence of psychosocial problems in women with UWP, and (iii) contraceptive use of women with UWP. METHODS GP registration data were analysed from 58 general practices located in Northern Netherlands between 2015 and 2019. Patient files were checked for registration of ICPC and ATC codes concerning pregnancy, psychosocial health, and contraceptive use. Chi-square and Fisher's exact test were used to calculate differences between women with a UWP and women with a wanted pregnancy (WP). An analysis of registration dates was conducted to determine when the psychosocial problems were registered in relation to the pregnancy. RESULTS Of female patients of reproductive age, 1.6% had a UWP and 11.8% had a WP. Women with a UWP reported statistically significantly more psychosocial problems. Furthermore, statistically significantly more contraceptive methods were prescribed to women with UWP compared with both women with WP and women without pregnancy. DISCUSSION AND CONCLUSION The finding that women with UWP experience more psychosocial problems can be used to improve aftercare and can be incorporated into current guidelines for GPs.
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Affiliation(s)
| | - Eline W Dalmijn
- Fiom, Research Department, 's-Hertogenbosch, The Netherlands
| | - Sophie H Bolt
- Fiom, Research Department, 's-Hertogenbosch, The Netherlands
| | - Feikje Groenhof
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, The Netherlands
| | - Lilian L Peters
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, The Netherlands
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Danielle E M C Jansen
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, The Netherlands
- Department of Sociology and Interuniversity Centre for Social Science Theory and Methodology (ICS), University of Groningen, Groningen, The Netherlands
- Accare, University Centre for Child and Adolescent Psychiatry, Groningen, The Netherlands
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12
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Nickels L, Yan W. Nonhormonal Male Contraceptive Development-Strategies for Progress. Pharmacol Rev 2023; 76:37-48. [PMID: 38101934 PMCID: PMC10759220 DOI: 10.1124/pharmrev.122.000787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 12/17/2023] Open
Abstract
Despite the widely demonstrated public health benefits of contraception, limited contraceptive options are available for men, placing both the contraceptive burden and opportunity solely on women. This review outlines the need for an increased focus on male contraceptive development and highlights several related topics, including the perspectives of women and men on male contraceptives, historical challenges, and reasons behind the persistent delays in male contraceptive development. It also discusses the importance of serendipitous observations in drug discovery and the limitations of depleting sperm or spermatogenic cells as a contraceptive approach. It further provides an overview of ongoing research and development on novel methods, with a goal to offer insights into the multifaceted aspects of nonhormonal male contraceptive development, addressing its implications for the health of men and women. SIGNIFICANCE STATEMENT: Despite well over half a century of effort in developing male contraceptives, there are no approved male contraceptive drugs on the market. This review aims to present strategies for progress in nonhormonal male contraception based on lessons learned from history, with the hope of expediting development and bringing a male contraceptive drug closer to reality.
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Affiliation(s)
- Logan Nickels
- Male Contraceptive Initiative, Durham, North Carolina (L.N.); The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California (W.Y.); and Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (W.Y.)
| | - Wei Yan
- Male Contraceptive Initiative, Durham, North Carolina (L.N.); The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California (W.Y.); and Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (W.Y.)
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13
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Yong MQY, Yeo Y, Shorey S. Factors affecting unintended pregnancy resolution from the perspectives of pregnant women and people: A systematic review of qualitative evidence. Midwifery 2023; 127:103866. [PMID: 37931463 DOI: 10.1016/j.midw.2023.103866] [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: 05/23/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Unintended pregnancy is a global issue with significant consequences for individuals and society. It impacts maternal and neonatal health, educational attainment, and interpersonal relationships. The decision-making process surrounding unintended pregnancies is complex, influenced by factors like ambivalence, societal norms, and maternal responsibilities. Understanding pregnant women and people's experiences is crucial to providing support and addressing barriers to access. Therefore, this systematic review aimed to consolidate and synthesize qualitative evidence regarding individual's experiences and the factors influencing their decision-making in unintended pregnancies. METHOD(S) Ten databases (PubMed, Embase, CINAHL Complete, Cochrane Library, PsycINFO (Ovid), Scopus, Web of Science Core Collection and Social Science Database (ProQuest), MedNar and ProQuest Dissertations and Theses Global) were systematically searched for published and unpublished primary qualitative studies from their inception to December 2022. Relevant qualitative data were extracted and meta-summarized using Sandelowski and Barroso's approach and analyzed using Thomas and Harden's thematic analysis framework. RESULTS Eighteen studies met the inclusion criteria and were included in the review. Four themes were identified from the meta-synthesis: 1) Navigating the head and heart, 2) Involvement and influence of others, 3) Hindrance and help in decision-making, and 4) Growing and gaining. CONCLUSION This review emphasized the significance of both internal and external factors in shaping pregnant women and people's experiences, and influencing their choices when faced with unintended pregnancies. Recognizing and addressing the multifaceted nature of these decisions; is crucial for different stakeholders such as healthcare professionals, and policymakers to better support pregnant women and people, and promote their well-being. This review sets the stage for future research and practice, emphasizing the ongoing need to empower pregnant women and people, ensure accessible and safe reproductive healthcare services, and promote informed decision-making.
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Affiliation(s)
- Megan Qing Yi Yong
- Division of Nursing, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229889, Singapore
| | - Yumi Yeo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Abdelhafez M, Ahmed K, Ahmed N, Ismail M, Mohd Daud MNB, Ping NPT, Eldiasty A, Amri MFB, Jeffree MS, Kadir F, pg Baharuddin DM, Bolong MFB, Hayati F, BtAzizan N, Sumpat D, Syed Abdul Rahim SS, Abdel Malek EH. Psychiatric illness and pregnancy: A literature review. Heliyon 2023; 9:e20958. [PMID: 37954333 PMCID: PMC10632674 DOI: 10.1016/j.heliyon.2023.e20958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
Background Women of reproductive age frequently suffer from psychiatric disorders. The risk of developing anxiety, bipolar, and depressive disorders is especially significant during the perinatal period. Objectives This article aims to identify and discuss the different psychiatric conditions that might affect pregnant women and update the mother's carers about the recent and updated bidirectional relationship between psychiatric disease and adverse pregnancy outcomes, As well as the most updates in diagnostic and management strategies. Methods A thorough analysis of the literature was conducted using database searches in EMBASE, Science Direct, Google Scholar, Scopus, and PubMed to obtain the objectives and aim of the study. Results The presence of maternal mental illness during pregnancy has been linked to preterm delivery, newborn hypoglycemia, poor neurodevelopmental outcomes, and disturbed attachment. Placental anomalies, small-for-gestational-age foetuses, foetal discomfort, and stillbirth are among more undesirable perinatal outcomes. Conclusions Pregnancy-related psychiatric disorders are frequent. The outcomes for pregnant women, infants, and women's health are all improved by proper diagnosis and treatment of psychiatric problems.
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Affiliation(s)
- MohsenM.A. Abdelhafez
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - KarimA.M. Ahmed
- Department of Dermatology, Helios Saint Johannes Klinikum, Duisburg, Germany
| | - NashwaA.M. Ahmed
- Department of Orthodontics, Faculty of Dental and Oral Surgery, Ahram Canadian University, Egypt
| | - MohdHamdy Ismail
- Owner and Leading Clinician, Ulti Care Dental Clinics, Cairo, Egypt
| | - Mohd Nazri Bin Mohd Daud
- Family Medicine Unit, Department of Public Health Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Nicholas Pang Tze Ping
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - AyaM. Eldiasty
- Department of Dermatology, Helios Saint Johannes Klinikum, Duisburg, Germany
| | - Mohd Fariz Bin Amri
- Department of Pathology and Microbiology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Mohammad Saffree Jeffree
- Department of Public Health Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Fairrul Kadir
- Department of Emergency Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Dg Marshitah pg Baharuddin
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Mohammed Firdaus Bin Bolong
- Department of Emergency Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Nornazirah BtAzizan
- Department of Clinical Pathology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Doreen Sumpat
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | | | - Ehab Helmy Abdel Malek
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
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15
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Li K, Lu J, Pang Y, Zheng X, Liu R, Ren M, Tu S. Maternal postpartum depression literacy subtypes: A latent profile analysis. Heliyon 2023; 9:e20957. [PMID: 37867796 PMCID: PMC10585387 DOI: 10.1016/j.heliyon.2023.e20957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023] Open
Abstract
Aim To explore the potential categories and characteristic differences of maternal postpartum depression literacy. Design Cross-sectional survey. Methods From February 2023 to April 2023, convenience sampling was used to survey 278 women attending postnatal visits to three tertiary level A hospitals. The study included general demographic characteristics, postpartum depression literacy scale, and family caring index scale. Latent profile analysis was performed to identify the categories of maternal postpartum depression literacy, and multiple disordered logistic regression was used to analyze the influencing factors of different categories. Results Maternal postpartum depression literacy was divided into three categories: low literacy (41.0 %), moderate literacy (32.4 %), and high literacy (26.6 %). The results showed that work status, education level, whether the pregnancy was planned, whether or not they had participated in mental health-related courses, and family functioning status were factors influencing the category of maternal postpartum depression literacy (P < 0.05). Conclusion There was heterogeneity in postpartum depression literacy among mothers. Medical staff should implement targeted interventions according to potential category characteristics and influencing factors to improve the level of postpartum depression literacy.
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Affiliation(s)
- Kangfen Li
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Jie Lu
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Yan Pang
- Department of Nursing, Chengdu Women and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xinlie Zheng
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Ran Liu
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Min Ren
- Department of Obstetrics, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Suhua Tu
- Nursing Department, Afliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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16
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Chen H, Chua TE, Lee TMY, Siak EJ, Hong LF, Ch'ng YC, Yasmin H, Chee CYI, Mok YM, Ong SH, Rajadurai VS, Teoh TG, Utravathy V, Tan KH, Tan LK. Consensus statement on Singapore Perinatal Mental Health Guidelines on Depression and Anxiety. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:467-475. [PMID: 38920193 DOI: 10.47102/annals-acadmedsg.2023148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
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.
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Affiliation(s)
- Helen Chen
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore
- Duke-National University of Singapore, Singapore
| | - Tze-Ern Chua
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore
- Duke-National University of Singapore, Singapore
| | - Theresa Mei Ying Lee
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore
- Duke-National University of Singapore, Singapore
| | - Elizabeth Junpei Siak
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore
- Duke-National University of Singapore, Singapore
| | - Lin Feng Hong
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore
- Duke-National University of Singapore, Singapore
| | - Ying Chia Ch'ng
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore
| | - Hassan Yasmin
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore
| | | | - Yee Ming Mok
- Department of Psychological Medicine, National University Hospital, Singapore
| | - Say How Ong
- Developmental Psychiatry, Institute of Mental Health, Singapore
| | | | - Tiong Ghee Teoh
- Obstetrics & Gynaecology, KK Women's and Children's Hospital, Singapore
| | | | - Kok Hian Tan
- Duke-National University of Singapore, Singapore
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Lay Kok Tan
- Duke-National University of Singapore, Singapore
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
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17
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Khan MN, Khanam SJ, Khan MMA, Islam MM, Harris ML. Effects of lower tiers of government healthcare facilities on unmet need for contraception and contraception use in Bangladesh. PLoS One 2023; 18:e0290468. [PMID: 37594992 PMCID: PMC10437788 DOI: 10.1371/journal.pone.0290468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND In low- and middle-income countries (LMICs), including Bangladesh, modern contraception use remains lower than desired, resulting in a higher unmet need. A potential factor contributing to lower contraceptive use is reduced access to and use of lower tiers of government healthcare facilities, including home visits by family welfare assistants (FWAs), as well as women's visits to community and satellite clinics. These relationships, however, are still unexplored in Bangladesh and LMICs more broadly. The aim of this study was to explore the effects of lower tiers of government healthcare facilities on unmet needs for contraception and contraception use in Bangladesh. METHODS Data from 17,585 sexually active married women were analyzed from the 2017 Bangladesh Demographic and Health Survey. The outcome variables were any contraceptive use, modern contraceptive use, unmet need for contraception, and unmet need for modern contraception. The explanatory variables considered were respondents' home visits by FWAs, respondents' visits to a community clinic, and respondents' visits to a satellite clinic. Multilevel mixed-effect Poisson regression with robust variance was used to determine the association between the outcome and explanatory variables, adjusted for individual-, household-, and community-level factors. RESULTS Approximately 18% of respondents were visited by FWAs in the three months prior to the survey date and only 3.4% and 3.1% of women attended community and satellite clinics, respectively. Women who reported being visited by FWAs in the three months prior to the survey were approximately 36% less likely to report an unmet need for modern contraception and 42% more likely to report using modern contraception than women who did not report such a visit. A higher likelihood of unmet need for contraception and a lower likelihood of contraception use were found among women who did not visit these community or satellite clinics or visited these clinics for other reasons than collecting contraception as compared to women who visited these clinics to collect contraception. CONCLUSION Home visits by FWAs to respondents' homes to provide contraception as well as respondents' visits to satellite and community clinics play a major role in Bangladesh to ensure contraception use and reduce the unmet need for contraception. However, their coverage is quite low in Bangladesh. The findings suggest an urgent need for greater government initiatives to increase the number of FWAs and proper monitoring of them at the field level.
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Affiliation(s)
- Md. Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh
| | - Shimlin Jahan Khanam
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh
| | | | - M. Mofizul Islam
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Melissa L. Harris
- Centre for Women’s Health Research, The University of Newcastle, Callaghan, NSW, Australia
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18
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Carlander A, Hultstrand JN, Reuterwall I, Jonsson M, Tydén T, Kullinger M. Unplanned pregnancy and the association with maternal health and pregnancy outcomes: A Swedish cohort study. PLoS One 2023; 18:e0286052. [PMID: 37216351 DOI: 10.1371/journal.pone.0286052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 05/08/2023] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVES Unplanned pregnancies are common and associated with late initiation and inadequate antenatal care attendance, which may pose health risks to mother and child. How pregnancy planning relates to maternal health and delivery in Sweden, a country with free antenatal care and free abortion, has not been studied previously. Our aims were to study whether pregnancy planning was associated with antenatal care utilization and pregnancy outcomes in a Swedish setting. METHODS Data for 2953 women, who answered a questionnaire when recruited at antenatal clinics in Sweden and later gave birth, was linked to the Swedish Medical Birth Register. The degree of pregnancy planning was estimated using the London Measure of Unplanned Pregnancy. Unplanned (comprising unplanned and ambivalent intention to pregnancy) was compared to planned pregnancy. Differences between women with unplanned and planned pregnancy intention and associated pregnancy outcomes were analyzed using Fisher's exact test and logistic regression. RESULTS There were 31% unplanned (2% unplanned and 29% ambivalent) pregnancies, whereas most woman (69%) reported their pregnancy to be planned. Women with an unplanned pregnancy enrolled later to antenatal care, but there was no difference in number of visits compared with planned pregnancy. Women with an unplanned pregnancy had higher odds to have induced labor (17% versus 13%; aOR 1.33 95% CI 1.06-1.67) and a longer hospital stay (41% versus 37%; aOR 1.21 95% CI 1.02-1.44). No associations were found between pregnancy planning and pregnancy-induced hypertension, gestational diabetes mellitus, preeclampsia, epidural analgesia use, vacuum extraction delivery, Caesarean section or sphincter rupture. CONCLUSIONS Unplanned pregnancy was associated with delayed initiation of antenatal care, higher odds for induction of labor and longer hospital stay, but not with any severe pregnancy outcomes. These findings suggest that women with an unplanned pregnancy cope well in a setting with free abortion and free health care.
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Affiliation(s)
- Alisa Carlander
- Department of Obstetrics and Gynecology, Region Västmanland, Västerås, Sweden
| | | | - Isa Reuterwall
- Department of Obstetrics and Gynecology, Region Västmanland, Västerås, Sweden
| | - Maria Jonsson
- Department of Women´s and Children's Health, Uppsala University, Uppsala, Sweden
| | - Tanja Tydén
- Department of Women´s and Children's Health, Uppsala University, Uppsala, Sweden
| | - Merit Kullinger
- Department of Obstetrics and Gynecology, Region Västmanland, Västerås, Sweden
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Hobby E, Mark NDE, Gemmill A, Cowan SK. Pregnancy intentions' relationship with infant, pregnancy, maternal, and early childhood outcomes: Evidence from births in Alaska, Missouri, and Oklahoma. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:62-76. [PMID: 36947635 DOI: 10.1363/psrh.12222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVES Much of reproductive health care policy in the United States focuses on enabling women to have intended pregnancies. Investigating whether the association between pregnancy intention and adverse outcomes for mothers and children in the immediate and longer term is due to intention or a mother's demographics provides valuable context for policy makers aiming to improve maternal and child outcomes. METHODS We investigated relationships between pregnancy intention and pregnancy, infant, early childhood, and maternal outcomes using data from the Pregnancy Risk Assessment Monitoring System survey, conducted 2-8 months after the child's birth, and follow-up surveys from three states (Alaska, Missouri, and Oklahoma), administered at age 2-3 years old. We used logistic regressions with inverse propensity weights to measure associations, accounting for potential confounding factors. RESULTS After inverse propensity weighting, pregnancy intention was associated with adverse maternal pregnancy behaviors but not most infant outcomes. Mothers who reported an unwanted pregnancy were associated with increased odds of the child receiving a developmental delay diagnosis. Among those who did not report depression prior to pregnancy, mothers with unwanted pregnancies were more likely to experience persistent depression, and mothers with pregnancies mistimed by two or more years had a higher likelihood of experiencing depression postpartum or in the follow up period. CONCLUSIONS Our findings suggest that pregnancy intention is less consequential for maternal and child well-being than socio-economic disadvantage, suggesting that re-orienting policy toward social conditions and reproductive autonomy will serve better individual and population health.
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Affiliation(s)
- Erica Hobby
- Cash Transfer Lab, New York University, New York, New York, USA
| | - Nicholas D E Mark
- Department of Sociology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Alison Gemmill
- Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sarah K Cowan
- Cash Transfer Lab, New York University, New York, New York, USA
- Department of Sociology, New York University, New York, New York, USA
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20
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Catalao R, Chapota H, Chorwe-Sungani G, Hall J. The impact of depression at preconception on pregnancy planning and unmet need for contraception in the first postpartum year: a cohort study from rural Malawi. Reprod Health 2023; 20:36. [PMID: 36849991 PMCID: PMC9972717 DOI: 10.1186/s12978-023-01576-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 01/25/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND The impact of depression on women's use of contraception and degree of pregnancy planning in low-income settings has been poorly researched. Our study aims to explore if symptoms of depression at preconception are associated with unplanned pregnancy and nonuse of contraception at the point of conception and in the postpartum period. METHODS Population-based cohort of 4244 pregnant women in rural Malawi were recruited in 2013 and were followed up at 28 days, 6 months and 12 months postpartum. Women were asked about symptoms of depression in the year before pregnancy and assessed for depression symptoms at antenatal interview using the Self-Reporting Questionnaire-20, degree of pregnancy planning using the London Measure of Unplanned Pregnancy and use of contraception at conception and the three time points postpartum. RESULTS Of the 3986 women who completed the antenatal interview, 553 (13.9%) reported depressive symptoms in the year before pregnancy and 907 (22.8%) showed current high depression symptoms. History of depression in the year before pregnancy was associated with inconsistent use of contraception at the time of conception [adjusted relative risk (adjRR) 1.52; 95% confidence interval (1.24-1.86)] and higher risk of unplanned [adjRR 2.18 (1.73-2.76)] or ambivalent [adj RR 1.75 (1.36-2.26)] pregnancy. At 28 days post-partum it was also associated with no use of contraception despite no desire for a further pregnancy [adjRR 1.49 (1.13-1.97)] as well as reduced use of modern contraceptives [adj RR 0.74 (0.58-0.96)]. These results remained significant after adjusting for socio-demographic factors known to impact on women's access and use of family planning services, high depression symptoms at antenatal interview as well as disclosure of interpersonal violence. Although directions and magnitudes of effect were similar at six and 12 months, these relationships were not statistically significant. CONCLUSIONS Depression in the year before pregnancy impacts on women's use of contraception at conception and in the early postpartum period. This places these women at risk of unplanned pregnancies in this high fertility, high unmet need for contraception cohort of women in rural Malawi. Our results call for higher integration of mental health care into family planning services and for a focus on early postnatal contraception.
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Affiliation(s)
- Raquel Catalao
- grid.37640.360000 0000 9439 0839King’s College London and South London and the Maudsley NHS Foundation Trust, London, UK
| | - Hilda Chapota
- Parent and Child Health Initiative Trust (PACHI) Program, Lilongwe, Malawi
| | - Genesis Chorwe-Sungani
- grid.10595.380000 0001 2113 2211Mental Health at Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
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21
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Mahmoudi P, Elyasi F, Nadi A, Ahmad Shirvani M. The Effect of Maternal-Foetal Attachment-Based Training Programme on Maternal Mental Health Following an Unintended Pregnancy. J Reprod Infant Psychol 2023; 41:26-42. [PMID: 34402709 DOI: 10.1080/02646838.2021.1959538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Unintended pregnancy is a risk factor for less maternal-fetal attachment (MFA) and low levels of psychological well-being. This study was conducted to determine the effect of an MFA-based training programme on maternal anxiety, depression and worries following an unintended pregnancy. METHODS This randomised clinical trial was conducted on 68 women with an unintended pregnancy in north of Iran during 2018-2019. Participants were allocated to the trained and control groups through simple randomisation. The trained group received the MFA-based training for three 90-min sessions. Demographic questionnaire, London measure of unplanned pregnancy, Cranley's MFA scale, Edinburgh postnatal depression, Spielberger anxiety and prenatal distress questionnaires were used. Data were analysed by descriptive statistics, chi square, Fisher's exact test, independent and paired-samples t-tests, Mann-Whitney U, analysis of covariance, and multivariate analysis of variance. RESULTS After the intervention, the mean MFA, anxiety and depression scores were not significantly different between the trained and control groups Worry was significantly decreased in the trained group (p = 0.001) and increased in the control group (p = 0.03). DISCUSSION Although the MFA-based training could not significantly improve MFA, maternal anxiety and depression, it has been effective on worry in women with the unintended pregnancies.
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Affiliation(s)
- Parastou Mahmoudi
- Student in Midwifery Counseling, Student Research Committee, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Forouzan Elyasi
- Department of Psychiatry, Psychiatry and Behavioral Sciences Research Center, Addiction Institute, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Aliasghar Nadi
- Department of Biostatistics, Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Marjan Ahmad Shirvani
- Department of Midwifery, Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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22
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Grace KT, Miller E. Future directions for reproductive coercion and abuse research. Reprod Health 2023; 20:5. [PMID: 36593505 PMCID: PMC9809032 DOI: 10.1186/s12978-022-01550-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/12/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Reproductive coercion and abuse (RCA) is a form of intimate partner violence (IPV) in which people with the capacity for pregnancy experience coercive behaviors that threaten their reproductive autonomy. Behaviors that constitute RCA include contraceptive control/sabotage, pregnancy pressure, and controlling the outcome of a pregnancy. Several areas of RCA study have emerged: associations with IPV, health outcomes resulting from RCA, and demographic and contextual factors associated with experiencing RCA. Current research in these areas is summarized and placed in a global context, including sexual and gender minority groups, use of RCA (exploring perpetration), RCA interventions, RCA in women with disabilities, and the question of whether people assigned male at birth can be RCA victims. CONCLUSION Areas for future exploration include evolving interpretations of pregnancy intention in the setting of fewer options for abortion, RCA in people with disabilities and multiple levels of marginalization, including sexual and gender minorities; intersections between RCA and economic abuse in the context of efforts at economic justice; and community-centered approaches to intervention and prevention.
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Affiliation(s)
- Karen Trister Grace
- grid.22448.380000 0004 1936 8032School of Nursing, College of Public Health, George Mason University, 4400 University Drive, Mailstop 3C4, Fairfax, VA 22030 USA
| | - Elizabeth Miller
- grid.21925.3d0000 0004 1936 9000Adolescent and Young Adult Medicine, University of Pittsburgh, 120 Lytton Avenue, Pittsburgh, PA 15213-1481 USA
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23
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Guertin J, Lanuza K. Novel Shared Decision-Making Tool Improves Contraceptive Screening and Right Care during Pregnancy in a Military Hospital: A Quality Improvement Report. J Midwifery Womens Health 2023; 68:125-134. [PMID: 36117403 DOI: 10.1111/jmwh.13403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 06/07/2022] [Accepted: 07/11/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Unintended pregnancy rates in the military remain high compared with rates outside of the military in the United States (54%-60% vs 45%-50%, respectively). Contraceptive counseling in conjunction with shared decision-making is recommended to improve military unintended pregnancy rates. Best counseling practices and decision aids for contraceptive counseling are unknown in military and nonmilitary populations. Pregnancy may be an opportune time to complete contraceptive counseling because of regularly scheduled prenatal visits, and counseling during pregnancy is associated with higher postpartum contraception use. A quality initiative was implemented to improve contraceptive screening and counseling during pregnancy for servicewomen and nonservicewomen in a clinic setting. PROCESS The initiative included 4 patient-centered core interventions: a patient screening, a shared decision-making tool, a right care checklist, and a team engagement plan, across 4 rapid plan-do-study-act cycles. OUTCOMES Contraceptive screening rates and delivery of right care improved from 37% to 79% in the pregnant patients over 90 days; 81% of patients screened positive for contraception needs; 89% of patients made a same-day decision about their contraception plan after completing the tool; and 92% of patients had a contraception plan documented in the electronic health record by the health care provider prior to birth. DISCUSSION Results demonstrated that contraception screening rates and right care improved with initiative interventions for servicewomen and nonservicewomen. A novel shared decision-making tool presented 18 contraception methods, risks and benefits, and tiered effectiveness that aided the majority of patients in a same-day decision with high patient satisfaction. Provider counseling was also simplified without delay in clinic time. Contraceptive counseling completed with a shared decision-making tool may benefit military and civilian populations during pregnancy. Additional research is needed to examine the best time to conduct counseling during pregnancy and the long-term rates of contraceptive use or unplanned pregnancy following counseling events.
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24
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Beumer WY, Roseboom TJ, Koot MH, Vrijkotte T, van Ditzhuijzen J. Carrying an unintended pregnancy to term and long-term maternal psychological distress: Findings from the Dutch prospective Amsterdam Born Children and their Development study. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231213737. [PMID: 38062674 PMCID: PMC10704944 DOI: 10.1177/17455057231213737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Given the estimated high rate of unintended pregnancies, it is important to investigate long-term effects on psychological distress in women carrying an unintended pregnancy to term. However, research into associations between unintended pregnancies carried to term and psychological distress postpartum is mixed, and especially, evidence on long-term associations is scarce. OBJECTIVE To examine whether carrying an unintended pregnancy to term is associated with maternal psychological distress later in life, up to 12 years postpartum. DESIGN This study is based on the population-based birth cohort study 'Amsterdam Born Children and their Development' study, which included pregnant people in 2003 (n = 7784) and followed them up until 12 years postpartum. METHODS Unintended pregnancy was measured as a multidimensional construct, based on self-reported data around 16 weeks gestation on pregnancy mistiming, unwantedness and unhappiness. Symptoms of maternal psychological distress were assessed around 3 months, 5 years and 12 years postpartum using multiple questionnaires measuring symptoms of depression, anxiety and stress. Multiple structural equation modelling models were analysed, examining the associations between dimensions of unintended pregnancy and maternal psychological distress per time point, while controlling for important co-occurring risks. RESULTS Pregnancy mistiming and unhappiness were significant predictors of more maternal psychological distress around 3 months postpartum. Around 5 years postpartum, only pregnancy mistiming was positively associated with maternal psychological distress. Dimensions of unintended pregnancy were no longer associated with maternal psychological distress around 12 years postpartum. Strikingly, antenatal psychological distress was a much stronger predictor of maternal psychological distress than pregnancy intention dimensions. CONCLUSION Those who carried a more unintended pregnancy to term reported more symptoms of psychological distress at 3 months and 5 years postpartum. People carrying an unintended pregnancy to term may benefit from extra support, not because of the pregnancy intentions per se, but because they may be related to antenatal psychological distress.
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Affiliation(s)
- Wieke Y Beumer
- Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gynaecology, Amsterdam, Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
| | - Tessa J Roseboom
- Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gynaecology, Amsterdam, Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
| | - Marjette H Koot
- Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gynaecology, Amsterdam, Netherlands
| | - Tanja Vrijkotte
- Amsterdam UMC location Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam, Netherlands
| | - Jenneke van Ditzhuijzen
- Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gynaecology, Amsterdam, Netherlands
- Social Policy and Public Health, Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
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25
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Murray AL, Taut D, Baban A, Hemady CL, Walker S, Osafo J, Sikander S, Tomlinson M, Toit SD, Marlow M, Ward CL, Fernando A, Madrid B, Van Thang V, Tuyen HD, Dunne M, Hughes C, Fearon P, Valdebenito S, Eisner M. Associations Between ADHD Symptoms and Maternal and Birth Outcomes: An Exploratory Analysis in a Multi-Country Cohort of Expectant Mothers. J Atten Disord 2022; 26:1882-1894. [PMID: 35815439 PMCID: PMC9597155 DOI: 10.1177/10870547221105064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE ADHD symptoms can adversely impact functioning in a range of domains relevant for maternal well-being and fetal development; however, there has been almost no research examining their impact during pregnancy. We aimed to address this gap. METHOD We used data (n = 1,204) from a longitudinal birth cohort study spanning eight countries to address this gap. RESULTS ADHD symptoms in the third trimester of pregnancy were associated with lower social support from family (b = -0.16, p = .031), friends (b = -0.16, p = .024), and significant others (b = -0.09, p = .001); higher stress (b = 0.34, p < .001) and depressive symptoms (b = 0.31, p < .001), and increased likelihood of an unwanted pregnancy (b = 0.30, p = .009). Significant associations with tobacco use (b = 0.36, p = .023) and premature birth (b = 0.35, p = .007) did not survive correction for multiple comparisons and there were no significant associations with alcohol use, low birth weight, or unplanned pregnancy. CONCLUSION Results suggest that women with ADHD symptoms could benefit from earlier, more regular screening for mental health difficulties and greater mental health support during pregnancy.
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Affiliation(s)
- Aja Louise Murray
- University of Edinburgh, UK,Aja Louise Murray, Department of
Psychology, University of Edinburgh, 7 George Square, Edinburgh EH8 9JZ, UK.
| | - Diana Taut
- Babes-Bolyai University, Cluj-Napoca,
Romania
| | | | | | - Susan Walker
- The University of the West Indies,
Kingston, Jamaica
| | | | | | - Mark Tomlinson
- Stellenbosch Uni`versity, Cape Town,
South Africa,Queens University, Belfast, UK
| | | | | | | | | | | | | | | | - Michael Dunne
- Queensland University of Technology,
Brisbane, Australia
| | | | | | | | - Manuel Eisner
- University of Cambridge, UK,University of Zurich,
Switzerland
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26
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Sasaki N, Ikeda M, Nishi D. Long-term influence of unintended pregnancy on psychological distress: a large sample retrospective cross-sectional study. Arch Womens Ment Health 2022; 25:1119-1127. [PMID: 36306037 DOI: 10.1007/s00737-022-01273-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/13/2022] [Indexed: 12/25/2022]
Abstract
This study examined the associations between childbirth decisions in women with unintended pregnancies and long-term psychological distress. An online survey of women selected from a representative research panel was conducted in July 2021. Among participants who experienced an unintended pregnancy, the childbirth decision was categorized: (i) wanted birth, (ii) abortion, (iii) adoption, and (iv) unwanted birth. Participants who made childbirth decisions more than 1 year ago were included. ANCOVA was conducted with psychological distress (Kessler 6) as the dependent variable and education, marital status, years from the decision, age of the first pregnancy, economic situation at the unintended pregnancy, and the number of persons consulted at the unintended pregnancy as covariates. Logistic regression analysis was conducted for high distress (K6 ≥ 13) by adjusting the same covariates. A total of 47,401 respondents participated in the study. Women with an experience of unintended pregnancy experienced more than 1 year before the study were analyzed (n = 7162). Psychological distress was the lowest for wanted birth and increased for abortion, adoption, and unwanted birth. In the adjusted model, abortion was associated with lower distress scores than both adoption and unwanted birth. Compared to the wanted birth, adoption and unwanted birth showed significantly higher levels of distress (adjusted odds ratio [aOR] = 2.03 [95% CI 1.36-3.04], aOR = 1.64 [95% CI 1.04-2.58], respectively). Long-term effects on psychological distress differed according to the childbirth decisions in unintended pregnancy. Healthcare professionals should be aware of this hidden effect of unintended pregnancy experience on women's mental health.
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Affiliation(s)
- Natsu Sasaki
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1Bunkyo-ku, HongoTokyo, 113-0033, Japan
| | - Mari Ikeda
- Department of Family Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1Bunkyo-ku, HongoTokyo, 113-0033, Japan.
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27
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Preis H, Djurić PM, Ajirak M, Chen T, Mane V, Garry DJ, Heiselman C, Chappelle J, Lobel M. Applying machine learning methods to psychosocial screening data to improve identification of prenatal depression: Implications for clinical practice and research. Arch Womens Ment Health 2022; 25:965-973. [PMID: 35986793 PMCID: PMC9709634 DOI: 10.1007/s00737-022-01259-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/07/2022] [Indexed: 11/30/2022]
Abstract
We utilized machine learning (ML) methods on data from the PROMOTE, a novel psychosocial screening tool, to quantify risk for prenatal depression for individual patients and identify contributing factors that impart greater risk for depression. Random forest algorithms were used to predict likelihood for being at high risk for prenatal depression (Edinburgh Postnatal Depression Scale; EPDS ≥ 13 and/or positive self-injury item) using data from 1715 patients who completed the PROMOTE. Performance matrices were calculated to assess the ability of the PROMOTE to accurately classify patients. Probability for depression was calculated for individual patients. Finally, recursive feature elimination was used to evaluate the importance of each PROMOTE item in the classification of depression risk. PROMOTE data were successfully used to predict depression with acceptable performance matrices (accuracy = 0.80; sensitivity = 0.75; specificity = 0.81; positive predictive value = 0.79; negative predictive value = 0.97). Perceived stress, emotional problems, family support, age, major life events, partner support, unplanned pregnancy, current employment, lifetime abuse, and financial state were the most important PROMOTE items in the classification of depression risk. Results affirm the value of the PROMOTE as a psychosocial screening tool for prenatal depression and the benefit of using it in conjunction with ML methods. Using such methods can help detect underreported outcomes and identify what in patients' lives makes them more vulnerable, thus paving the way for effective individually tailored precision medicine.
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Affiliation(s)
- Heidi Preis
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794, USA.
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11794, USA.
| | - Petar M Djurić
- Department of Electrical and Computer Engineering, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Marzieh Ajirak
- Department of Electrical and Computer Engineering, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Tong Chen
- Department of Electrical and Computer Engineering, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Vibha Mane
- Department of Electrical and Computer Engineering, Stony Brook University, Stony Brook, NY, 11794, USA
| | - David J Garry
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Cassandra Heiselman
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Joseph Chappelle
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794, USA
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11794, USA
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Perinatal depression and its impact on infant outcomes and maternal-nurse SMS communication in a cohort of Kenyan women. BMC Pregnancy Childbirth 2022; 22:723. [PMID: 36138357 PMCID: PMC9494796 DOI: 10.1186/s12884-022-05039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 09/09/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Perinatal depression is broadly defined as depressive symptoms during pregnancy or within the 12 months following delivery, affecting approximately 20-25% of pregnant and postpartum women in low- and middle-income countries. The wide accessibility of mobile phones allows mobile health (mHealth) interventions to be considered a solution to identify perinatal depression and provide appropriate referrals for treatment. This study, nested in a larger SMS communication project, examined the prevalence and correlates of perinatal depression, determined the association between antenatal depression and infant morbidity and mortality, and compared SMS communication patterns between women with and without perinatal depression. METHODS This was a prospective longitudinal cohort study of pregnant women seeking antenatal services at two public sector health clinics in Kenya. SMS messages were sent to participants with educational content related to their pregnancy and infant health and two-way SMS communication occurred with a nurse. Sociodemographic and obstetric characteristics, SMS messaging behaviors, infant health status, and depressive symptoms were assessed by a standardized questionnaire administered at enrollment (30-36 weeks gestation) and follow-up (14 weeks postpartum). Generalized estimating equation (GEE) with Poisson link was used to evaluate correlates of perinatal depressive symptoms, infant outcomes, and frequency of SMS messaging. RESULTS Of the 572 women with complete follow-up information, 188 (32.9%) screened positive for elevated depressive symptoms (≥10 by EPDS scale) at some time point during pregnancy or postpartum. The strongest predictors of any depressive symptoms included interpersonal abuse during pregnancy, fewer years of schooling, and maternal unemployment. Antenatal depressive symptoms were associated with an increased risk of infant illness or hospitalization (RR = 1.12, 95% CI: 1.11, 1.13). Women with antenatal or persistent perinatal depressive symptoms sent fewer SMS messages during the study period than their counterparts without depression. CONCLUSIONS Prevalence of elevated perinatal depressive symptoms was high in this cohort of Kenyan women. Our findings highlight the importance of screening perinatal women for experiences of symptoms of depression as well as abuse. Differences in messaging frequency between women with vs. without depressive symptoms presents an opportunity to provide more tailored support for those perinatal depression.
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Khan MN, Islam MM. Women's experience of unintended pregnancy and changes in contraceptive methods: evidence from a nationally representative survey. Reprod Health 2022; 19:187. [PMID: 36050768 PMCID: PMC9438238 DOI: 10.1186/s12978-022-01492-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Ineffective or no use of contraception following an unintended pregnancy contributes to a subsequent unintended pregnancy. This study aimed to determine whether women’s experiences of unintended pregnancies affect changing their contraceptive using patterns. Methods We analysed the 2017/2018 Bangladesh Demographic and Health Survey data. The contraceptive switching pattern was computed by comparing women’s contraceptives using data before and after pregnancy. Women were categorised into the following three groups, depending on their patterns of contraceptive use before and after pregnancy: no change, if there were no change in contraceptive using pattern; switched to higher effective contraceptives, if changed from pre-pregnancy less effective contraceptives to post-pregnancy more effective contraceptives; switched to less effective contraceptives, if changed from pre-pregnancy more effective contraceptives to post-pregnancy less effective contraceptives. Women’s intention in the most recent pregnancy was our primary explanatory variable, classified as wanted, mistimed and unwanted. Multinomial multilevel logistics regression was used to determine the association between women’s intention in the most recent pregnancy and women’s contraceptive methods switching patterns from before to after pregnancy. Results Around 20% of the most recent pregnancies that ended with a live birth were unintended at conception. No contraceptive use was reported by 37% of women before their pregnancies which decreased to 24% after pregnancies. Overall, around 54% of women who reported no contraceptive use before pregnancy used modern contraceptives after pregnancy. The rate was higher among women who experienced unwanted pregnancy (73.4%) than mistimed (58.8%) and wanted (53.4%) pregnancy. Experience of mistimed pregnancy was associated with a higher likelihood of no contraceptive change (aOR, 1.84, 95% CI 1.41–2.39) and switching to less effective contraceptives (aOR, 1.58, 95% CI 1.10–2.26) than switching to more effective contraceptives. However, unwanted pregnancy was not associated with any significant change in contraceptives use from before to after pregnancy. Conclusion Experience of unintended pregnancy did not change women’s contraception using patterns, which indicates the risk of repeat unintended pregnancies and associated adverse consequences, including maternal and child morbidity and mortality. Policies to ensure access to and use of modern contraceptives among women facing unwanted or mistimed pregnancies are recommended. Unintended pregnancy is considered a public health challenge in low- and middle-income countries (LMICs). Around 89% of the global occurrences of unintended pregnancies occur in LMICs. In absolute numbers, this is equivalent to nearly 88 million pregnancies. Adverse pregnancy consequences, including bleeding, haemorrhage and maternal mortality are common in this group. The adverse consequences are even higher among women facing unintended pregnancies more than once, i.e., repeat unintended pregnancies, which represent around half of the total occurrences of unintended pregnancies in LMICs. Ensuring proper access to effective contraceptives following birth is key to reducing repeat unintended pregnancies and associated adverse consequences. It is critical to know the patterns of women’s pre-pregnancy contraceptive methods use and whether experiences of unintended pregnancies affect their contraceptive methods uptake and their types. However, this data is completely lacking in the context of LMICs. Using nationally representative survey data from Bangladesh, we examined women’s contraceptive switching patterns from before to after pregnancy and their association with pregnancy types. We found increased likelihood of no change in contraceptive using pattern or switching to less effective contraceptives among women after they experienced mistimed pregnancy compared to those whose pregnancy was wanted. This pattern increases the risk of repeat unintended pregnancies in Bangladesh and associated adverse consequences, including maternal and child morbidity and mortality.
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Affiliation(s)
- Md Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, 2222, Bangladesh.
| | - M Mofizul Islam
- Department of Public Health, La Trobe University, Melbourne, 3086, Australia
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30
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Trajectories and Correlates of Anger During the Perinatal Period. J Obstet Gynecol Neonatal Nurs 2022; 51:599-611. [PMID: 35987262 DOI: 10.1016/j.jogn.2022.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVES To investigate trajectories of anger during pregnancy and the early postpartum period; to identify baseline psychosocial predictors of anger trajectory group membership; and to examine correlates of anger trajectory group membership, including symptoms of depression, anxiety, insomnia, and social support, in the postpartum period. DESIGN Longitudinal descriptive design. SETTING We recruited participants from a maternity clinic in Calgary, Alberta, Canada. PARTICIPANTS The sample included a convenience sample of 143 pregnant women who had basic fluency in English, were older than 17 years of age, and were less than 19 weeks gestation with a single fetus at the time of recruitment. METHODS Participants completed online questionnaires at four time points: early, mid-, and late pregnancy and 2 months after birth. We used group-based semiparametric mixture modeling to estimate patterns of anger. We used multinomial logistic regression to explore associations between baseline predictors and trajectory membership. RESULTS We identified four distinct trajectories of anger during pregnancy through 2 months after birth: minimal-stable anger (52.4%), mild-stable anger (27.5%), moderate-stable anger (12.7%), and high-decreasing anger (7.4%). Membership in the moderate-stable group was associated with greater baseline symptoms of depression, anxiety, and insomnia severity scores compared to the minimal-stable anger group. Moderate-stable trajectory group membership was also associated with greater symptoms of anxiety, depression, and insomnia at 2 months after birth. CONCLUSION Higher levels of anger were associated with worse mental health in pregnancy and after childbirth in our participants. Women should be made aware of anger as a possible mood disturbance by clinicians, and researchers should investigate the consequences of anger during the perinatal period.
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Simoni MK, Gilstad-Hayden K, Naqvi SH, Pal L, Yonkers KA. Progression of depression and anxiety symptoms in pregnancies conceived by assisted reproductive technology in the United States. J Psychosom Obstet Gynaecol 2022; 43:214-223. [PMID: 34472405 PMCID: PMC10116357 DOI: 10.1080/0167482x.2021.1971193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Women who utilize assisted-reproductive technology (ART) to achieve pregnancy experience unique circumstances before and during their pregnancy. This study aims to examine the progression of mental health in pregnant women who conceived via various methods of ART to understand gestational time periods of emotional stability or risk specific to these populations. METHODS Secondary analysis of the Yale Pink and Blue Study - a prospective cohort involving women from 137 obstetrical practices in the northeastern United States between 2005-2009. Depressive and anxiety symptoms among spontaneous, planned pregnancies were compared to ART pregnancies using the Edinburgh Postnatal Depression Scale (EPDS) and its anxiety subscale (EPDS-3A), respectively. Generalized Estimating Equations were used to compare group changes (EPDS and EPDS-3A score threshold ≥10) at timepoints of <17 weeks (T1), 28(±2) weeks (T2), and 8(±4) weeks postpartum (T3). RESULTS 1,466 spontaneous, planned pregnancies were compared to 191 pregnancies conceived via ART. Prevalence of depressive symptoms were similar between conception groups. Change in prevalence over time differed significantly between those groups (from T1 to T3 (β 0.59), as well as between spontaneous pregnancies compared to autologous gamete ART pregnancies (from T1 to T2 (β 0.48) and T1 to T3 (β 0.65). Course of anxiety did not differ between conception groups. CONCLUSIONS Women who conceive via ART have different rates of change in depressive symptoms throughout gestation compared to women with spontaneous pregnancies.
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Affiliation(s)
- Michael K Simoni
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT USA
| | | | - Syed H Naqvi
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT USA
| | - Lubna Pal
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT USA
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Niven K, Kovac R, Tayba L, Varghese S, Nguyen T. The sexual and reproductive health of female psychiatric inpatients: An area needing more attention? Australas Psychiatry 2022; 30:386-390. [PMID: 35320036 DOI: 10.1177/10398562221082434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Trauma-informed care and physical (including sexual and reproductive) health screening is standard in Western Australian mental health settings. We sought to determine the rates of reported sexual trauma and domestic violence (DV), the rates of sexual and reproductive health screening, and associations between sexual trauma and reproductive health screening in a sample of women of child-bearing age (WOCBA), that is, 18-49 years, admitted to an inpatient psychiatric unit (IPU). METHODS A retrospective study on 12 months of admissions to an outer metropolitan IPU (2017-2018), using descriptive analysis. RESULTS Review of 160 admissions demonstrated high rates of reported sexual trauma (49.4%) and DV (38.8%). Rates of screening for pregnancy (56.9%) and sexually-transmitted infection risk (18.8%) were low. 5 out of 25 (20.0%) patients prescribed a mood stabiliser had documented discussions regarding reproductive risks of their medication. An overall lack of effect (p > .6) was found between sexual trauma history and reproductive health screening. CONCLUSIONS WOCBA admitted to an IPU are vulnerable to having experienced sexual trauma and DV, with low rates of documented reproductive health screening despite existing clinical guidelines.
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Affiliation(s)
- Katie Niven
- 94267North Metropolitan Health Service, Claremont, WA, Australia
| | - Rachel Kovac
- 94267North Metropolitan Health Service, Claremont, WA, Australia
| | - Layale Tayba
- 94267North Metropolitan Health Service, Claremont, WA, Australia
| | - Sunny Varghese
- Peel and Rockingham/Kwinana Mental Health Service, Rockingham, WA, Australia
| | - Thinh Nguyen
- Peel and Rockingham/Kwinana Mental Health Service, Rockingham, WA, Australia; University of Western Australia, Perth, WA, Australia
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Grace KT, Holliday CN, Bevilacqua K, Kaur A, Miller J, Decker MR. Sexual and Reproductive Health and Reproductive Coercion in Women Victim/Survivors Receiving Housing Support. JOURNAL OF FAMILY VIOLENCE 2022; 38:713-722. [PMID: 35283554 PMCID: PMC8901387 DOI: 10.1007/s10896-022-00362-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Abstract
Housing instability and intimate partner violence (IPV) compromise women's sexual and reproductive health (SRH) through reduced contraceptive access and increased risk of unintended pregnancy. This study describes the reproductive health status and needs of IPV survivors receiving housing support and explores factors influencing their experience of reproductive coercion (RC), specifically. Cross-sectional baseline data from a quasi-experimental study of 70 IPV survivors enrolled in housing programs in the Baltimore, MD, metropolitan area from June 2019 through December 2020 were analyzed. Of the 70 women enrolled in the study, 70.3 percent (n = 45) desired to avoid pregnancy, but 57.4 percent were either using no contraceptive method (31.2%) or methods with low effectiveness (26.2%). Approximately, 1 in 6 women (16.4%, n = 11) experienced RC in the past 3 months, which was associated with frequency and severity of IPV (p = 0.001 to 0.005) and PTSD (p = 0.001), as well as not sharing children with the abusive partner (p = 0.002). This study highlights reproductive health risks in an important and under-studied population of women seeking housing due to IPV. Leaving an abusive relationship is a uniquely vulnerable time, and also a time of opportunity, as women are accessing services that can be tailored to their SRH needs. Significant results highlight vulnerability to and consequences of RC in this population. This study has implications for IPV support programs and housing programs that serve women.
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Affiliation(s)
- Karen Trister Grace
- School of Nursing, College of Health and Human Services, George Mason University, 4400 University Drive, MSN 3C4, Fairfax, VA 22030 USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | | | | | - Arshdeep Kaur
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Moreau C, Bonnet C, Beuzelin M, Blondel B. Pregnancy planning and acceptance and maternal psychological distress during pregnancy: results from the National Perinatal Survey, France, 2016. BMC Pregnancy Childbirth 2022; 22:162. [PMID: 35227224 PMCID: PMC8883609 DOI: 10.1186/s12884-022-04496-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 02/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Studies report heightened risks of mental health problems among women who experience an unintended pregnancy, but few consider the complexity of pregnancy intentions. In this study, we evaluate how different dimensions of pregnancy intentions (pregnancy planning and pregnancy acceptance) relate to two maternal depressive symptoms and perceived psychological distress. Methods This study draws from a cross-sectional national survey conducted in all maternities in France over a one-week period in 2016. All mothers 18 years and older who had a live birth during the study period were invited to participate. After excluding women who underwent infertility treatment, our analytical sample included 10,339 women. We first described levels and correlates of pregnancy planning and acceptance, defined in four categories; planned/welcomed, unplanned/welcomed, planned/unwelcomed, unplanned/unwelcomed. We then assessed the bivariate and multivariate associations between pregnancy planning and acceptance and two outcomes: women’s self-perceived psychological health and the presence of two depressive symptoms during pregnancy. We used multivariate logistic regressions to evaluate these associations, after adjusting for socio-demographic and medical factors. Results Altogether 7.5 to 24.1% of mothers perceived their psychological health during pregnancy was poor, according to pregnancy planning and acceptance categories and 10.3 to 22.4% indicated feelings of sadness and loss of interest during pregnancy, according to pregnancy planning and acceptance categories. As compared to women with planned/welcomed pregnancies, the odds of perceived poor psychological health and depressive symptoms were 2.55 times (CI 2.20–2.95) and 1.75 times higher (CI 1.51–2.02), respectively, among unplanned/unwelcomed pregnancies and 2.02 (CI 1.61–2.53) and 2.07 (CI 1.7–2.5) higher, among planned/unwelcomed pregnancies. Among women with unplanned pregnancies, we also found higher odds of perceived poor psychological health among women whose pregnancy was unwelcomed while the odds of depressive symptoms were not different by pregnancy planning status among women with unwelcomed pregnancies. Conclusions These findings consolidate previous reports of the association between pregnancy intentions and maternal psychological distress, while further specifying the relationship, which mostly depends on the acceptance of pregnancy timing rather than on pregnancy planning. Identifying women with low pregnancy acceptance can potentially enhance current medical practice by improving early detection of maternal depression.
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Affiliation(s)
- Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21203, USA. .,Soins et Santé Primaire, CESP Centre for Research in Epidemiology and Population Health, U1018, INSERM, F-94805, Villejuif, France.
| | - Camille Bonnet
- Obstetrical, Perinatal and Pediatric Research Team, INSERM, Université de Paris, F-75014, Paris, France
| | - Maxime Beuzelin
- Obstetrical, Perinatal and Pediatric Research Team, INSERM, Université de Paris, F-75014, Paris, France
| | - Béatrice Blondel
- Obstetrical, Perinatal and Pediatric Research Team, INSERM, Université de Paris, F-75014, Paris, France
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Schonewille NN, Rijkers N, Berenschot A, Lijmer JG, van den Heuvel OA, Broekman BFP. Psychiatric vulnerability and the risk for unintended pregnancies, a systematic review and meta-analysis. BMC Pregnancy Childbirth 2022; 22:153. [PMID: 35216573 PMCID: PMC8876535 DOI: 10.1186/s12884-022-04452-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background Unintended pregnancies (UPs) are a global health problem as they contribute to adverse maternal and offspring outcomes, which underscores the need for prevention. As psychiatric vulnerability has previously been linked to sexual risk behavior, planning capacities and compliance with contraception methods, we aim to explore whether it is a risk factor for UPs. Methods Electronic databases were searched in November 2020. All articles in English language with data on women with age ≥ 18 with a psychiatric diagnosis at time of conception and reported pregnancy intention were included, irrespective of obstetric outcome (fetal loss, livebirth, or abortion). Studies on women with intellectual disabilities were excluded. We used the National Institutes of Health tool for assessment of bias in individual studies and the Grading of Recommendations Assessment, Development and Evaluation method for assessment of quality of the primary outcome. Findings Eleven studies reporting on psychiatric vulnerability and UPs were included. The participants of these studies were diagnosed with mood, anxiety, psychotic, substance use, conduct and eating disorders. The studies that have been conducted show that women with a psychiatric vulnerability (n = 2650) have an overall higher risk of UPs compared to women without a psychiatric vulnerability (n = 16,031) (OR 1.34, CI 1.08–1.67) and an overall weighed prevalence of UPs of 65% (CI 0.43–0.82) (n = 3881). Interpretation Studies conducted on psychiatric vulnerability and UPs are sparse and many (common) psychiatric vulnerabilities have not yet been studied in relation to UPs. The quality of the included studies was rated fair to poor due to difficulties with measuring the outcome pregnancy intention (use of various methods of assessment and use of retrospective study designs with risk of bias) and absence of a control group in most of the studies. The findings suggest an increased risk of UPs in women with psychiatric vulnerability. As UPs have important consequences for mother and child, discussing family planning in women with psychiatric vulnerabilities is of utmost importance. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04452-1.
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Affiliation(s)
- N N Schonewille
- Department Psychiatry and Medical Psychology, OLVG, Oosterpark 9, 1091 AC, Amsterdam, Netherlands.
| | - N Rijkers
- Department Psychiatry and Medical Psychology, OLVG, Oosterpark 9, 1091 AC, Amsterdam, Netherlands
| | - A Berenschot
- Medical Library, OLVG, Oosterpark 9, 1091 AC, Amsterdam, Netherlands
| | - J G Lijmer
- Department Psychiatry and Medical Psychology, OLVG, Oosterpark 9, 1091 AC, Amsterdam, Netherlands
| | - O A van den Heuvel
- Department Psychiatry and Department Anatomy & Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Boelelaan 1118, 1081 HV, Amsterdam, Netherlands
| | - B F P Broekman
- Department Psychiatry and Medical Psychology, OLVG, Oosterpark 9, 1091 AC, Amsterdam, Netherlands.,Department Psychiatry, Vrije Universiteit Amsterdam, Amsterdam UMC, Boelelaan 1118, 1081 HV, Amsterdam, Netherlands
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Mark NDE, Cowan SK. Do Pregnancy Intentions Matter? A Research Note Revisiting Relationships Among Pregnancy, Birth, and Maternal Outcomes. Demography 2022; 59:37-49. [PMID: 35040479 DOI: 10.1215/00703370-9710311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The prevention of unplanned or unintended pregnancies continues to be a cornerstone of U.S. reproductive health policy, but the evidence that such pregnancies cause adverse maternal and child outcomes is limited. In this research note, we examine these relationships using recent large-scale data and inverse propensity weights estimated from generalized boosted models. We find that pregnancy timing is related to maternal experience during pregnancy, but not to infant outcomes at birth-both of which are consistent with prior research. In an addition to the literature, we show that pregnancy timing is relevant for a number of maternal outcomes, such as the onset of depression and intimate partner violence, changes in smoking behavior, and receipt of medical care. These findings suggest that policy intended to improve infant welfare by preventing unintended pregnancies has little empirical support, but that policy focused on increasing reproductive autonomy and maternal well-being has the potential to improve outcomes.
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Affiliation(s)
| | - Sarah K Cowan
- Department of Sociology, New York University, New York, NY, USA
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Prevalence of depression during pregnancy and postpartum periods in low-income women in developed countries. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-021-01662-3] [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] Open
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Muskens L, Boekhorst MGBM, Kop WJ, van den Heuvel MI, Pop VJM, Beerthuizen A. The association of unplanned pregnancy with perinatal depression: a longitudinal cohort study. Arch Womens Ment Health 2022; 25:611-620. [PMID: 35347473 PMCID: PMC9072423 DOI: 10.1007/s00737-022-01225-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/18/2022] [Indexed: 12/25/2022]
Abstract
Perinatal depression is common, affecting approximately 7-13% of women. Studies have shown an association between unplanned pregnancy and perinatal depressive symptoms, but many used a cross-sectional design and limited postnatal follow-up. The current study investigated the association of unplanned pregnancy with perinatal depressive symptoms using a longitudinal cohort study that followed women from the first trimester until 12 months postpartum. Pregnant women (N = 1928) provided demographic and clinical data and information about pregnancy intention at the first trimester. Depressive symptoms were assessed during each trimester of pregnancy and five times postpartum using the Edinburgh Postnatal Depression Scale (EPDS) until 12 months postpartum. Mixed model analyses were used to investigate the association between an unplanned pregnancy and the level of depressive symptoms. Women with an unplanned pregnancy (N = 111, 5.8%) reported persistently higher levels of depressive symptoms during the entire perinatal period compared to women with a planned pregnancy, after adjustment for confounders (p < 0.001). However, the course of depressive symptom scores over time in women with an unplanned pregnancy was similar to that of women with a planned pregnancy. Lower age (p = 0.006), unemployment (p = 0.004), and history of depression (p < 0.001) were significantly associated with higher levels of perinatal depressive symptoms. An unplanned pregnancy may have a long-lasting negative impact on a woman's perinatal mental health. Therefore, women with an unplanned pregnancy may benefit from systematic follow-up during the perinatal period with contingent mental health support.
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Affiliation(s)
- Lotte Muskens
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, Netherlands.
| | - Myrthe G. B. M. Boekhorst
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB Tilburg, Netherlands
| | - Willem J. Kop
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB Tilburg, Netherlands
| | | | - Victor J. M. Pop
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB Tilburg, Netherlands
| | - Annemerle Beerthuizen
- Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, Netherlands
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Rastad Z, Golmohammadian M, Jalali A, Kaboudi B, Kaboudi M. Effects of positive psychology interventions on happiness in women with unintended pregnancy: randomized controlled trial. Heliyon 2021; 7:e07789. [PMID: 34471708 PMCID: PMC8387909 DOI: 10.1016/j.heliyon.2021.e07789] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/15/2021] [Accepted: 08/11/2021] [Indexed: 01/23/2023] Open
Abstract
Background Undesirable effects Negative feelings among women with unintended pregnancies may have undesirable effects on pregnancy. However, little is known about the effect of positive feelings and protective factors on prenatal mental health of pregnant women. The aim of the present study was to determine the effect of positive psychology-based interventions (PPI) on the happiness of women with unintended pregnancies. Methods This randomized controlled trial that included 40 women with unintended pregnancies was conducted between March and July 2017. The subjects were randomly assigned to receive 10 weekly training sessions based on positive psychology (PPI) (N = 20) or routine prenatal care (N = 20). All subjects received usual prenatal care. The level of happiness and its five domains were measured in three time points: at baseline, immediately after completing the intervention, and 45 days after the end of the intervention. The happiness was assessed using the Oxford Happiness Inventory (OHI). Results In the intervention group, the mean total OHI score increased from 31.3 (at baseline) to 42.5 (after completing ten sessions of PPI), and the increase remained statistically significant at a 45-day follow-up (39.8); P = 0.001. However, the total OHI score did not change significantly during the follow-up (P = 0.339). Satisfaction with life, self-esteem, and subjective well-being improved significantly after the interventions, whereas the increases observed in the scores of positive mood and self-efficacy dimensions were not significant. Conclusion PPIs can improve happiness and its dimensions among women with unintended pregnancies. It is suggested that healthcare planners help women with unplanned pregnancies adapt by formulating strategies to hold training courses with a positive psychology approach and recognize and promote their positive aspects and strengths.
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Affiliation(s)
- Zahra Rastad
- Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Golmohammadian
- Department of Counseling, Faculty of Social Sciences, Razi University, Kermanshah, Iran
| | - Amir Jalali
- Department of Psychiatric Nursing, School of Nursing and Midwifery, Medical University of Kermanshah, Kermanshah, Iran
| | - Bijan Kaboudi
- Center of Cardiovascular Research, Medical University of Kermanshah, Kermanshah, Iran
| | - Marzieh Kaboudi
- Department of Reproductive Health, School of Nursing and Midwifery, Medical University of Kermanshah, Kermanshah, Iran
- Corresponding author.
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Feld H, Barnhart S, Wiggins AT, Ashford K. Social support reduces the risk of unintended pregnancy in a low-income population. Public Health Nurs 2021; 38:801-809. [PMID: 33938034 PMCID: PMC8419072 DOI: 10.1111/phn.12920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 11/29/2022]
Abstract
Almost half of all pregnancies (45%) in the United States (US) are unintended, with the highest concentration in women with low incomes. Targeted research is warranted to identify risk and protective factors that influence pregnancy intention to improve maternal/child health. PURPOSE To identify individual and interpersonal level associations to pregnancy intention to use as leverage points to build resilience. METHOD A cross-sectional, secondary analysis of Medicaid eligible pregnant women in Kentucky (n = 309). RESULTS Sixty-two percent reported their current pregnancy was unintended. Older age, partnered, negative drug screen, and increased social support were associated with decreased odds of unintended pregnancy. For every 1 unit increase of belonging and tangible social support, women were 13% and 14% (respectively) less likely to have an unintended pregnancy (OR = 0.87, 95% CI = 0.78-0.97, p = .011, OR = 0.86, 95% CI = 0.77-0.95, p = .005). A positive drug screen was associated with an almost three-fold increase in the odds of unintended pregnancy (OR = 2.88, 95% CI = 1.49-5.58, p = .002). CONCLUSION Public health nurses can play a critical role in reducing unintended pregnancy rates by promoting social support, inclusion, and acceptance. There remains a critical need to identify barriers and facilitators to pregnancy planning for persons who use illicit drugs.
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Affiliation(s)
- Hartley Feld
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Sheila Barnhart
- College of Social Work, University of Kentucky, Lexington, KY, USA
| | | | - Kristin Ashford
- College of Nursing, University of Kentucky, Lexington, KY, USA
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Chan KL. The Role of Father Involvement and Intimate Partner Violence on Postnatal Depression Among Women With Unintended Pregnancy. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP9864-NP9884. [PMID: 31296100 DOI: 10.1177/0886260519862274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study set out to fill the research gap by including various aspects of father involvement and intimate partner violence (IPV) in the examination of the association between unintended pregnancy and maternal postnatal depression (PND). This study aimed to examine the effect of father involvement and IPV on the association between unintended pregnancy and PND. A sample of 1,083 pregnant women who attended antenatal clinic at selected hospitals in Hong Kong completed two surveys to report on their pregnancy intention, antenatal depression, PND, IPV during pregnancy, their partner's (i.e., father's) involvement during pregnancy and after childbirth, and perceived social support. Comparisons were made between women with unintended pregnancy and those with intended pregnancy, and the effects of unintended pregnancy, father involvement, IPV, and other factors on maternal PND were examined. Results show that women with unintended pregnancy were more likely to report PND, IPV, fear, postnatal stress, lower degree of father involvement, and lower level of social support. Unintended pregnancy independently increased the risk of PND by 1.95 times (95% confidence interval [CI] = [1.15, 3.28]), after adjustment for all other variables. When father involvement was included in the regression model, the negative effects of IPV and the related fear on PND became nonsignificant. The positive association between unintended pregnancy and PND was robust. Father involvement might help promote maternal health by reducing the negative effects of IPV on PND.
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Yu P, Jiang Y, Zhou L, Li K, Xu Y, Meng F, Zhou Y. Association between pregnancy intention and smoking or alcohol consumption in the preconception and pregnancy periods: A systematic review and meta-analysis. J Clin Nurs 2021; 31:1113-1124. [PMID: 34459054 DOI: 10.1111/jocn.16024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 12/16/2022]
Abstract
AIMS To investigate the association between pregnancy intention and smoking or alcohol consumption in preconception and pregnancy periods. BACKGROUND Suboptimal lifestyle such as smoking and alcohol consumption can lead to devastating outcomes on the maternal and foetus. Pregnancy intention exerts a significant effect on promoting healthy lifestyle behaviours. However, no reliable evidences confirmed pregnancy intention was associated with smoking and alcohol consumption before and during pregnancy. DESIGN Systematic review and meta-analysis. METHODS We performed a comprehensive search from databases including PubMed, Cochrane, Web of Science, IEEE Xplore, MEDLINE, ProQuest and Scopus from the inception of these databases up to November, 2020. All eligible studies exploring the association between pregnancy intention and smoking or alcohol consumption were included. The fixed- or random effect pooled measure was used to estimate the odds ratio (OR) or risk ratio (RR) and 95% CI. In addition, the PRISMA checklist was used in this meta-analysis. RESULTS A total of 23 studies were included in this systematic review and meta-analysis. During pregnancy, the findings suggested that women with unplanned pregnancy were 68% more likely to consume cigarettes (OR = 1.68, 95% CI = 1.44-1.95) and 44% more likely to consume alcohol (OR = 1.44, 95% CI = 1.15-1.81) than those women with planned pregnancy. Meanwhile, during preconception, women with unplanned pregnancy were 30% more likely to consume cigarettes (OR = 1.30, 95% CI = 1.10-1.53) and 20% more likely to consume alcohol (OR = 1.20, 95% CI = 1.01-1.42) than those women with planned pregnancy. CONCLUSION The findings suggested that women with unplanned pregnancy were more likely to follow unhealthy behaviours such as smoking and alcohol consumption before and during pregnancy. Health professionals should consider the women's desire for pregnancy to decrease preconception and pregnancy smoking or alcohol consumption in future studies. RELEVANCE OF CLINICAL PRACTICE Pregnancy intention is the key determinant of smoking and alcohol consumption during preconception and pregnancy periods. Offering effective contraception in primary healthcare setting could prevent unplanned pregnancy. Meanwhile, popularising minimal alcohol consumption and comprehensive smoke-free legislation would be beneficial to improve reproductive outcomes.
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Affiliation(s)
- Pengli Yu
- School of Nursing, Qingdao University, Qingdao, China
| | - Yunxia Jiang
- School of Nursing, Qingdao University, Qingdao, China
| | - Lixue Zhou
- School of Nursing, Qingdao University, Qingdao, China
| | - Kuinan Li
- School of Nursing, Qingdao University, Qingdao, China
| | - Yanhong Xu
- School of Nursing, Qingdao University, Qingdao, China
| | - Fei Meng
- School of Nursing, Qingdao University, Qingdao, China
| | - Yunping Zhou
- School of Nursing, Qingdao University, Qingdao, China
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A Nationwide Mystery Caller Evaluation of Oral Emergency Contraception Practices from German Community Pharmacies: An Observational Study Protocol. Healthcare (Basel) 2021; 9:healthcare9080945. [PMID: 34442082 PMCID: PMC8391881 DOI: 10.3390/healthcare9080945] [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: 04/25/2021] [Revised: 06/04/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022] Open
Abstract
To prevent unwanted pregnancies, oral emergency contraception (EC) with the active ingredients levonorgestrel (LNG) and ulipristal acetate (UPA) is recommended by the guidelines of the German Federal Chamber of Pharmacists (BAK). In this respect, community pharmacies (CPs) in Germany have a major responsibility for information gathering, selecting the appropriate medicine, availability and pricing, among other things. Therefore, it would be appropriate to conduct a study with the aim of investigating information gathering, a possible recommendation as well as availability and pricing for oral EC in German CPs. A representative nationwide observational study based on the simulated patient methodology (SPM) in the form of covert mystery calls will be conducted in a random sample of German CPs stratified according to the 16 federal states. Each selected CP will be randomly called once successfully by one of six both female and male trained mystery callers (MCs). The MCs will simulate a product-based scenario using the request for oral EC. For quality assurance of the data collection, a second observer accompanying the MC is planned. After all mystery calls have been made, each CP will receive written, pharmacy-specific performance feedback. The only national SPM study on oral EC to date has identified deficits in the provision of self-medication consultations with the help of visits in the CPs studied. International studies suggest that UPA in particular is not always available. Significant price differences could be found analogous to another German study for a different indication.
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Ueno Y, Kako M, Ohira M, Okamura H. Shared decision-making for women facing an unplanned pregnancy: A qualitative study. Nurs Health Sci 2021; 22:1186-1196. [PMID: 33159478 DOI: 10.1111/nhs.12791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 11/28/2022]
Abstract
This study aimed to explore the competencies of health care practitioners who promote shared decision-making (SDM)-based care for women facing an unplanned pregnancy in Japan. We conducted semistructured interviews with 12 care providers who are pioneers in care for women facing an unplanned pregnancy and adopted a modified grounded theory approach for data analysis. A three-step model for shared decision making in practice (team talk, option talk, and decision talk) was used as a reference. The answers given by the care providers were analyzed to identify the competencies involved in shared decision making. We identified three stages: (i) building trust and promoting women's expression; (ii) discussing women's real needs; and (iii) exploring the intentions and goals expressed by women and finding the best choices while promoting women's autonomy in decision-making. The coordination between the support of partners, families, and professionals, and the care provided to strengthen women's identities facilitated shared decision making. Women facing an unplanned pregnancy can benefit from interventions designed to improve shared decision making. A key component of shared decision making-based care relates to practitioners' raised awareness toward their roles and responsibilities: developing good communication skills and fostering collaboration between all stakeholders.
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Affiliation(s)
- Yoko Ueno
- Graduate School of Biomedical and Sciences, Hiroshima University, Hiroshima, Japan
| | - Mayumi Kako
- Graduate School of Biomedical and Sciences, Hiroshima University, Hiroshima, Japan
| | - Mitsuko Ohira
- Graduate School of Biomedical and Sciences, Hiroshima University, Hiroshima, Japan
| | - Hitoshi Okamura
- Graduate School of Biomedical and Sciences, Hiroshima University, Hiroshima, Japan
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Hua MH, Huang KL, Hsu JW, Bai YM, Su TP, Tsai SJ, Li CT, Lin WC, Chen TJ, Chen MH. Early Pregnancy Risk Among Adolescents With ADHD: A Nationwide Longitudinal Study. J Atten Disord 2021; 25:1199-1206. [PMID: 31971056 DOI: 10.1177/1087054719900232] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective: ADHD potentially leads to risky sexual behaviors, and is considered a major risk factor for early pregnancy (EP). However, the association between ADHD and subsequent EP remains unknown. Method: Seven thousand five hundred five adolescents with ADHD and 30,020 age- and sex-matched individuals without ADHD were enrolled from 2001 to 2009 and were followed until the end of 2011. Adolescents who developed any pregnancy (at age ≤30 years) or EP (at age <20 years) during the follow-up period were identified. Results: Adolescents with ADHD were found to be prone to pregnancy (hazard ratio [HR] = 1.27) and EP (HR = 2.30) compared with those without ADHD. Long-term ADHD medication use was related to a lower risk of subsequent any pregnancy (HR = 0.72) and EP (HR = 0.69). Conclusion: Adolescents with ADHD had an increased risk of any pregnancy and EP compared with their non-ADHD counterparts. Long-term ADHD medication use was associated with a lower subsequent EP risk.
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Affiliation(s)
| | - Kai-Lin Huang
- Taipei Veterans General Hospital, Taipei.,National Yang-Ming University, Taipei
| | - Ju-Wei Hsu
- Taipei Veterans General Hospital, Taipei.,National Yang-Ming University, Taipei
| | - Ya-Mei Bai
- Taipei Veterans General Hospital, Taipei.,National Yang-Ming University, Taipei
| | - Tung-Ping Su
- Taipei Veterans General Hospital, Taipei.,National Yang-Ming University, Taipei.,Cheng Hsin General Hospital, Taipei
| | - Shih-Jen Tsai
- Taipei Veterans General Hospital, Taipei.,National Yang-Ming University, Taipei
| | - Cheng-Ta Li
- Taipei Veterans General Hospital, Taipei.,National Yang-Ming University, Taipei
| | - Wei-Chen Lin
- Taipei Veterans General Hospital, Taipei.,National Yang-Ming University, Taipei
| | - Tzeng-Ji Chen
- Taipei Veterans General Hospital, Taipei.,National Yang-Ming University, Taipei
| | - Mu-Hong Chen
- Taipei Veterans General Hospital, Taipei.,National Yang-Ming University, Taipei
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Tasnim F, Rahman M, Islam MM, Rahman MM. Association of pregnancy intention with postpartum depression within six months postpartum among women in Bangladesh. Asian J Psychiatr 2021; 61:102686. [PMID: 34020319 DOI: 10.1016/j.ajp.2021.102686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Fowzia Tasnim
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, 6205, Bangladesh
| | - Mymuna Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, 6205, Bangladesh
| | - Md Monimul Islam
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, 6205, Bangladesh
| | - Md Mosfequr Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, 6205, Bangladesh.
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Robbins CL, Zapata LB, D'Angelo D, Brewer LI, Pazol K. Pregnancy Intention: Associations with Maternal Behaviors and Experiences During and After Pregnancy. J Womens Health (Larchmt) 2021; 30:1440-1447. [PMID: 34190626 PMCID: PMC10102922 DOI: 10.1089/jwh.2021.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The associations between levels of pregnancy intention and adverse behaviors or experiences during pregnancy and postpartum have not been well described. Materials and Methods: We used 2018 Pregnancy Risk Assessment Monitoring System data from 31 jurisdictions in the United States (n = 32,777) to estimate prevalence of inadequate prenatal care (PNC), inappropriate gestational weight gain, depression during pregnancy, intimate partner violence (IPV) during pregnancy, third trimester smoking, no breastfeeding, no postpartum visit, postpartum depressive symptoms, and postpartum smoking by categories of pregnancy intention: unwanted, ambivalent (i.e., unsure), mistimed (i.e., wanted later), or wanted (i.e., wanted then/sooner). Regression models estimated adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) of associations between pregnancy intention and maternal behaviors or experiences. Results: Approximately 16% of women reported pregnancy ambivalence. Women with pregnancy ambivalence (versus wanted pregnancies) had higher prevalence of all adverse maternal behaviors and experiences. Separate models found women with unwanted pregnancy (vs. ambivalent) had higher prevalence for depression during pregnancy (aPR: 1.40, 95% CI: 1.21-1.63), IPV (aPR: 1.75, 95% CI: 1.11-2.77), no breastfeeding (aPR: 1.22, 95% CI: 1.04-1.44), no postpartum visit (aPR: 1.28, 95% CI: 1.06-1.55), and postpartum depressive symptoms (aPR: 1.19, 95% CI: 1.00-1.42); Women with mistimed pregnancy (vs. ambivalent) had lower prevalence for inadequate PNC (aPR: 0.89, 95% CI: 0.81-0.98), third trimester smoking (aPR: 0.68, 95% CI: 0.57-0.80), no breastfeeding (aPR: 0.85, 95% CI: 0.74-0.98), and postpartum smoking (aPR: 0.83, 95% CI: 0.73-0.95). Discussion: The results emphasize the importance of recommended screening and care during the preconception, prenatal, and postpartum periods.
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Affiliation(s)
- Cheryl L Robbins
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lauren B Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,U.S. Public Health Service Commissioned Corps, Atlanta, Georgia, USA
| | - Denise D'Angelo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lara I Brewer
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karen Pazol
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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NEJAD FATEMEKHAJOEI, SHAHRAKI KATAYOUNALIDOUSTI, NEJAD PARVINSALEHI, MOGHADDAM NOSHIRVANKHEZRI, JAHANI YONES, DIVSALAR PARISA. The influence of mindfulness-based stress reduction (MBSR) on stress, anxiety and depression due to unwanted pregnancy: a randomized clinical trial. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E82-E88. [PMID: 34322621 PMCID: PMC8283654 DOI: 10.15167/2421-4248/jpmh2021.62.1.1691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/22/2021] [Indexed: 11/16/2022]
Abstract
Background Individuals with unwanted pregnancies often experience high levels of anxiety, stress and depression that associated with maternal-neonatal outcomes. Mindfulness training is a safe and acceptable strategy to support mental health before parturition. Purpose The main objective of present study was to evaluate the influence of eight-week application of mindfulness-based stress reduction on stress, anxiety and depression caused by unplanned pregnancy. Method In this study, 60 women with unwanted pregnancy before 32 weeks of gestational age were selected and randomly divided into two groups. Intervention group received MBSR sessions, practice at home and the recorded sound. Mental health was evaluated before intervention and at the end of the eight sessions by standard stress, anxiety and depression DASS-21 questionnaire. Data were analyzed using Chi-square, Mann-Whitney U and Wilcoxon tests. Findings In order to compare pre-test and post-test scores in each group, the Wilcoxon Test was used. The results revealed that the participants in the intervention group reported a significant decrease in mean scores of stress, anxiety and depression compared to baseline (P = 0.0). Whereas no significant decrease in mean stress, anxiety and depression score were found in control group. P-value was estimated to be 0.346, 0.212 and 0.343 respectively. Conclusions The mindfulness program has effectively reduced stress, anxiety and depression. Further research is needed to investigate the mechanisms and effects of mindfulness on maternal-neonatal outcomes.
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Affiliation(s)
- FATEME KHAJOEI NEJAD
- Nursing Research Center, Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - KATAYOUN ALIDOUSTI SHAHRAKI
- Midwifery Department, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Iran
- Correspondence: Katayoun Alidousti Shahraki, Midwifery Department, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Iran - Tel.: 09132421749 - Fax: 03431325218 - E-mail: -
| | - PARVIN SALEHI NEJAD
- Department of Midwifery, Razi School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | | | - YONES JAHANI
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran - Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - PARISA DIVSALAR
- Assistant professor of psychiatry, fellowship of psychosomatic Medicine, MD, Neuroscience Research Center, Institute of Neuropharmacology, Department of Psychiatry, School of medicine, Kerman University of Medical Sciences, Kerman, Iran
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Skouteris H, Savaglio M. The Use of Social Media for Preconception Information and Pregnancy Planning among Young Women. J Clin Med 2021; 10:jcm10091892. [PMID: 33925520 PMCID: PMC8123806 DOI: 10.3390/jcm10091892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/14/2021] [Accepted: 04/25/2021] [Indexed: 01/21/2023] Open
Abstract
Young women of reproductive age (18–25 years) often seek and engage with health-related information via social media. However, the extent to which this population group seek preconception and pregnancy-related information has not been explored. Therefore, this study aimed to: (1) examine the proportion, type, and frequency of social media use to seek general health, preconception, and pregnancy-related information or advice among young women; and (2) explore the relationship between age, education status, relationship status, and planning a pregnancy on social media use for preconception and pregnancy-related health information. Ninety-one Australian women aged 18–25 years completed an online survey about their patterns and preferences of social media use for this information. Forty percent of women used social media for general health information (most often daily), 32% for preconception health advice (most commonly weekly), and 20% for pregnancy-related information (most often weekly), with Facebook the most frequently used platform. Planning a pregnancy within the next 5 years and younger age were associated with greater likelihood of using social media for such information. It is necessary that social media platforms are leveraged to disseminate preconception and pregnancy planning health advice, support, and education to provide better health promotion and preventive care to young women.
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Affiliation(s)
- Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;
- Warwick Business School, The University of Warwick, Coventry CV4 7AL, UK
- Correspondence:
| | - Melissa Savaglio
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;
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Association between delivering live-born twins and acute psychiatric illness within 1 year of delivery. Am J Obstet Gynecol 2021; 224:302.e1-302.e23. [PMID: 32926857 DOI: 10.1016/j.ajog.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/01/2020] [Accepted: 09/09/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Having twins is associated with more depressive symptoms than having singletons. However, the association between having twins and psychiatric morbidity requiring emergency department visit or inpatient hospitalization is less well known. OBJECTIVE This study aimed to determine whether women have higher risk of having a psychiatric diagnosis at an emergency department visit or inpatient admission in the year after having twins vs singletons. STUDY DESIGN This retrospective cohort study used International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes within the Florida State Inpatient Database and State Emergency Department Database, which have an encrypted identifier allowing nearly all inpatient and emergency department encounters statewide to be linked to the medical record. The first delivery of Florida residents at the age of 13 to 55 years from 2005 to 2014 was included, regardless of parity; women with International Classification of Diseases, Ninth Revision, Clinical Modification coding for psychiatric illness or substance misuse during pregnancy or for stillbirth or higher-order gestations were excluded. The exposure was an International Classification of Diseases, Ninth Revision, Clinical Modification code during delivery hospitalization of live-born twins. The primary outcome was an International Classification of Diseases, Ninth Revision, Clinical Modification code during an emergency department encounter or inpatient admission within 1 year of delivery for a psychiatric morbidity composite (suicide attempt, depression, anxiety, posttraumatic stress disorder, psychosis, acute stress reaction, or adjustment disorder). The secondary outcome was drug or alcohol use or dependence within 1 year of delivery. We compared outcomes after delivery of live-born twins with singletons using multivariable logistic regression adjusting for sociodemographic and medical factors. We tested for interactions between independent variables in the primary model and conducted sensitivity analyses stratifying women by insurance type and presence of severe intrapartum morbidity or medical comorbidities. RESULTS A total of 17,365 women who had live-born twins and 1,058,880 who had singletons were included. Within 1 year of birth, 1.6% of women delivering twins (n=270) and 1.6% of women delivering singletons (n=17,236) had an emergency department encounter or inpatient admission coded for psychiatric morbidity (adjusted odds ratio, 1.00; 95% confidence interval, 0.88-1.14). Coding for drug or alcohol use or dependence in an emergency department encounter or inpatient admission in the year after twin vs singleton delivery was also similar (n=96 [0.6%] vs n=6222 [0.6%]; adjusted odds ratio, 1.11; 95% confidence interval, 0.91-1.36). However, women with public health insurance were more likely to be coded for drug or alcohol use or dependence after twin than singleton delivery (n=75 [1.2%] vs n=4858 [1.0%]; adjusted odds ratio, 1.27; 95% confidence interval, 1.01-1.60). Women with ≥1 medical comorbidity, severe maternal morbidity, or low income also had an increased risk of psychiatric morbidity after twin delivery (comorbidities, n=7438 [42.8%]; adjusted odds ratio, 1.30; 95% confidence interval, 1.25-1.34; severe maternal morbidity, n=940 [5.4%]; adjusted odds ratio, 1.65; 95% confidence interval, 1.49-1.81; lowest income quartile, n=4409 [26.8%]; adjusted odds ratio, 1.31; 95% confidence interval, 1.23-1.40; second-lowest income quartile, n=4770 [29.0%]; adjusted odds ratio, 1.34; 95% confidence interval, 1.26-1.43). CONCLUSION Overall, diagnostic codes for psychiatric illness or substance misuse in emergency department visits or hospital admissions in the year after twin vs singleton delivery are similar. However, women with who are low income or have public health insurance, comorbidities, or severe maternal morbidity are at an increased risk of postpartum psychiatric morbidity after twin vs singleton delivery.
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