Unintended pregnancy and postpartum depression: A meta-analysis of cohort and case-control studies

Years of education mediate the association between adverse childhood experiences and unintended pregnancy: A population-based study in Japan

BACKGROUND

Adverse childhood experiences (ACEs) have been associated with unintended pregnancies, including mistimed pregnancies (MP) and unwanted pregnancies (UWP). However, it remains unknown which cluster of ACEs (i.e., child maltreatment/household dysfunction and deprivation/threat) are associated with MP/UWP and whether years of education mediate these associations.

OBJECTIVE

To investigate the association of the clusters of ACEs with MP and UWP, while also examining the mediating effect of education years.

PARTICIPANTS AND SETTING

A retrospective cohort study among 7652 postpartum women in Chiba, Japan.

METHODS

MP/UWP was defined by emotional responses to confirming pregnancy. Multinomial logistic regression analyses with multiple imputed datasets estimated the relative risk ratio (RRR) of MP/UWP by cumulative scores and each cluster of ACEs. Causal mediation analysis assessed the indirect effects of years of education.

RESULTS

Women with 4 or more ACEs were at a 2.4 times higher risk of MP (95 % confidence interval (CI): 1.6-3.8) and a 5.0 times higher risk of UWP (95 % CI: 3.1-8.2). Among ACE clusters, having 3 or more household dysfunction showed the strongest association with MP (RRR: 1.91, 95 % CI: 1.23-2.95), and having 3 or more deprivation showed the strongest association with UWP (RRR: 3.69, 95 % CI: 2.00-6.83). Education years mediated 16 % and 11 % of the association between total ACEs and MP/UWP, respectively, with a similar trend observed in each cluster.

CONCLUSIONS

Not only ACEs score but also each cluster of ACEs was associated with MP and UWP. The mediating effects of years of education were modest.

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

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.

The prevalence of unintended pregnancy and its influence on pregnancy experience in Tabriz, Iran, 2023: a cross-sectional study

BACKGROUND

There is a lack of quantitative studies that specifically measure the association between the experience of pregnancy and unintended pregnancy. The present study aims to address the prevalence of unintended pregnancy and identify its predictors. Additionally, the study explores whether unintended pregnancy is associated with pregnancy uplifts and hassles.

METHODS

This cross-sectional study was conducted on 488 pregnant women between 20 to 40 weeks' gestation at the comprehensive health center in Tabriz City from February 2022 to January 2023. A cluster sampling method was used for sampling, and data were collected using socio-demographic questionnaires and the Pregnancy Experience Scale (PES). Descriptive statistics were used to describe the socio-demographic characteristics and the prevalence of unintended pregnancy. Binary logistic regression was employed to identify the predictors of pregnancy desirability. To examine the relationship between unintended pregnancy and pregnancy experience, an independent t-test was used for bivariate analysis, and a general linear model (GLM) was utilized for multivariate analysis, with control for potential confounding variables.

RESULTS

The prevalence of unintended pregnancies was 30.7% (24.3% unwanted pregnancies, and 6.4% mistimed pregnancies). The results of the binary logistic regression indicated that the lower age of both the woman and her spouse were significant predictors for unintended pregnancy (P < 0.05). Based on an independent t-test, the mean score for uplifts in women with unintended pregnancy was significantly lower than in women with intended pregnancy (mean difference (MD): -4.99; 95% confidence interval (CI): -5.96 to -4.02; p < 0.001), While the mean score of hassles in women with unintended pregnancy was significantly higher than women with intended pregnancy (MD: 2.92; 95% CI: 2.03 to 3.80; p < 0.001). The results of GLM showed that women who had unintended pregnancies had significantly lower scores for uplifts (B = -4.99; 95% CI: -5.96 to -4.03; P < 0.001) and higher scores for hassles (B = 2.92; 95% CI: 2.06 to 3.78; P < 0.001).

CONCLUSIONS

The high prevalence of unintended pregnancies in Tabriz highlights the importance of targeted interventions to address this issue, considering the policy framework and unique challenges faced by women. Future studies should focus on developing context-specific interventions that effectively meet the needs of women with unintended pregnancies.

Reducing behavior problems in children born after an unintended pregnancy: the generation R study

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.

College student perceptions of pharmacist-provided hormonal contraception

BACKGROUND

North Carolina immunizing pharmacists are authorized to provide oral and transdermal hormonal contraception to eligible patients. In March 2022, implementation of this enhanced patient care service began statewide, after approval of standing orders and published training from the North Carolina Association of Pharmacists. Two pharmacy locations on a college campus began offering pharmacist-provided hormonal contraception shortly after approval.

OBJECTIVE

The objective of this study was to assess the willingness of students to seek pharmacist-provided hormonal contraception and the willingness of students to pay for this service.

METHODS

This cross-sectional study was conducted on the campus of a public, research-intensive university. To be included, individuals must have been 18 years of age or older, enrolled as a student or postdoc at the university, and must have used prescribed hormonal oral contraception within the last year. Individuals who declined consent or surveys that were not at least 90% complete were excluded. The survey was administered via Qualtrics and distributed via e-mail and printed flyers with a QR code. The survey opened February 10, 2023, and closed April 24, 2023.

RESULTS

In total, 170 survey responses were analyzed. Almost three-fourths of participants (72.9%) were not aware that pharmacists could provide hormonal contraception in North Carolina. All participants identified at least one benefit to pharmacist-provided contraception, with the most common responses being "I believe it would save time" (85.3%) and "appointment not needed" (89.4%). Almost two-thirds of participants (65.3%) identified at least one barrier that would prevent them from seeking pharmacist-provided contraception. The most common barrier identified was privacy at the pharmacy (20.0%). Most participants (81.8%) reported that they are willing to pay for this service, with the majority willing to pay up to $29.

CONCLUSION

Students on this campus seem to have a receptive attitude toward pharmacist-provided hormonal contraception and are willing to pay for a consultation.

Online Intervention Targeting Postnatal Depression and Anxiety in Chilean First-Time Mothers: Feasibility Trial

OBJECTIVE

Internet-based interventions may positively impact maternal symptoms of postnatal depression and anxiety. This study assessed the feasibility, acceptability, perceived usefulness, and preliminary effectiveness of an m-Health version of "What Were We Thinking?" (m-WWWT).

METHODS

A mixed-methods with a 2-arm randomized parallel design was used. From a total of 477 women, 157 met the inclusion criteria. 128 first-time mothers of full-term infants, aged 4-10 weeks, who received health care at primary public health centers in Chile, were randomly assigned to the experimental (EG, n = 65) or control (CG, n = 63) groups; data of 104 of them (53 and 51, respectively) was analyzed. We used percentages and rates to measure feasibility outcomes and mixed analysis of variance (ANOVA) and latent class analyses (LCA) to assess preliminary effectiveness. Participants completed questionnaires on mental health, social support, and maternal self-efficacy upon recruitment and 3 months after completing the intervention. For the qualitative component, 12 women from the EG were interviewed.

RESULTS

Quantitative results show good feasibility outcomes, such as high recruitment (82%), low attrition (EG = 12% and CG = 17%), and high follow-up (EG = 97% and CG = 91%) rates. Qualitative results indicate high acceptability and perceived usefulness of m-WWWT. Mixed ANOVA did not show significant differences between the groups (all p >.05). However, multinomial regression analysis in LCA showed that women with low baseline symptoms of depression and anxiety benefit from the intervention (B = 0.43, 95% confidence interval 1.09-2.16).

CONCLUSION

m-WWWT is feasible to be implemented in Chile; future studies are needed to assess the intervention's effectiveness.

An exploration of the contraceptive counselling practices of midwives who provide postpartum care in Australia

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.

Teenage and young adult pregnancy and depression: findings from the Japan environment and children's study

Teenage pregnancy increases the threat of depression because of its many factors. Pregnancy during young adulthood may also have several risk factors for depression compared to older pregnancies. However, data on depression in young adult pregnancies are lacking. This study investigated the association between teenage and young adult pregnancy and depression. Data from the Japan Environment and Children's study was used as a nationwide multicenter prospective cohort study. A multivariate logistic regression was performed to investigate the association between age groups (14-19, 20-24, 25-29, 30-34, ≥ 35 years) and depression, adjusted for behavioral and sociodemographic characteristics. Depression was assessed using the Kessler Psychological Distress Scale. In total, 96,808 pregnant women responded to the questionnaire. Teenage (14-19 years) and young adult (20-24 years) pregnancy were associated with an increased risk of depression compared to older pregnancy (≥ 35 years) (teenage: OR 4.28, 95% confidence interval, CI [3.24-5.64]; young adult: OR 3.00, 95% CI [2.64-3.41]). After adjusting for covariates, the magnitude of the risk of depression was attenuated. However, teenage and young adult pregnancy remained at a significantly increased risk of depression compared to older pregnancy (teenage: OR 2.38, 95% CI [1.77-3.21]; young adult: OR 2.14, 95% CI [1.87-2.46]). Our findings indicate that teenage and young adults' pregnancy are at an increased risk of depression compared to older pregnancy. These findings suggest prioritizing teenage and young pregnant women for prevention and interventions related to depression.

Postpartum depression and its relationship with the positive and negative perfectionism

BACKGROUND

Depression is a common mental disorder after childbirth, which has serious consequences for the mother, baby, and family. A wide range of causes, including some personality traits of mothers, are involved in its etiology. Therefore, this study was conducted aiming to determine the factors related to postpartum depression (PPD) and its relationship with positive and negative perfectionism in Qom, Iran.

MATERIALS AND METHODS

This cross-sectional analytical study was conducted on 162 mothers who had been referred to health centers in Qom during 6-8 weeks after normal vaginal delivery (NVD) in 2020. After randomly classifying the health centers, the convenience sampling method was carried out. Data collection tools included social-individual information form, Edinburg Postnatal Depression Scale (EPDS), and Positive and Negative Perfectionism Questionnaire of Terry-Short. The data were analyzed using the Chi-square and Pearson correlation tests and multivariate logistic regression analysis.

RESULT

The prevalence of PPD in this study was 29.6%. The results showed that with the increase in the negative dimension of perfectionism, the chance of PPD in people increases by 14% (OR = 1.14, CI = 1.06-1.21), while there was no significant correlation between the positive dimension of perfectionism and PPD (r = 0.006, P > 0.05). Furthermore, the chance of PPD was higher in student mothers, mothers who had a history of PPD, and unintended pregnancy. Moreover, some factors such as multigravidity, breastfeeding, and not worrying about body image reduce the chance of occurrence.

CONCLUSION

Since mothers' negative perfectionism is associated with PPD, it is recommended to identify perfectionist individuals during pregnancy and after delivery and provide counseling service to them.

The Importance of Personal and Familial Factors on Breastfeeding Intention and Practices, and Postpartum Distress during the Pandemic: A Longitudinal Observational Study

BACKGROUND

The COVID-19 pandemic has significantly impacted pregnant and breastfeeding women. Both low- and high-risk groups adopted preventive approaches such as mask-wearing and handwashing to slow down and prevent viral transmission during critical periods that may affect mother-child interactions.

METHODS

A longitudinal observational study was conducted with primiparous women recruited using convenience sampling from the postpartum care ward of Afzalipour Teaching Hospital in Kerman from August 1, 2020 to March 30, 2021. The research questionnaires included demographic information, preventive behaviors, breastfeeding intention and practices, postpartum distress, and Edinburgh Postpartum Depression Scale. All the questionnaires were self-reported online in three stages: before discharge from the postpartum ward, the first month after delivery, and the third month after delivery.

RESULTS

A Total of 160 primiparous women were included. The results showed significant changes in preventive behaviors and postpartum distress levels during the study. Breastfeeding intention and practices were negatively affected by postpartum distress (P = 0.034), unwanted pregnancies (P = 0.009), and cesarean delivery (P < 0.001). Postpartum distress was directly affected by the presence of depression (P < 0.001). Preventive behaviors at discharge were significantly associated with postpartum distress three months after delivery (P = 0.013). The study also found an association between women's and partner's education, unwanted pregnancy, and cesarean delivery that determined postpartum distress.

CONCLUSIONS

Pandemic restrictions did not affect breastfeeding intentions or practices, possibly due to sufficient social and family support during the pandemic. However, robust guidelines are required to increase enable women's access to specializede care to cope with future pandemics, particularly during the first few weeks after childbirth.

Associations of unintended pregnancy with autism spectrum disorders and the modification of folic acid supplements

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.

Maternal Antibiotic Exposure and the Risk of Developing Antenatal or Postpartum Depressive Symptoms: The Maternal Experience Study Protocol

Limited epidemiological evidence suggests a link between antibiotic use and developing depression. This study seeks to investigate this association in depth, using a cohort of pregnant individuals. The primary aim is to explore any association between the use of antibiotics during pregnancy and the development of antenatal depressive symptoms up to the third trimester, as well as the use of antibiotics during pregnancy and within 12 months postpartum and the development of postpartum depressive symptoms. A national prospective, observational, longitudinal cohort study has been designed to examine these relationships. A sample size of 1500 pregnant individuals has been sought for this study, assuming 10 potential predictor variables (including antibiotic use) in the final multiple logistic regression model and allowing for a 30% drop-out rate. The development of depressive symptoms is considered either a diagnosis by a medical doctor and/or a scoring 13 or higher on the Edinburgh Postnatal Depression Scale. Data will be collected during the third trimester and at 6 weeks, 6 months, and 12 months postpartum. These surveys include variables previously identified as associated with antenatal and postpartum depression (e.g., level of social support, experience of intimate partner abuse, and obstetric complications), as well as antibiotic and probiotic use. This study will provide an update on the prevalence of the symptoms of depression during pregnancy and postpartum and its associated risk factors. It will also, for the first time, comprehensively explore the potential association between antibiotic use during pregnancy and up to 12 months postpartum and the development of depressive symptoms.

Early-stage pregnancy recognition on microblogs: Machine learning and lexicon-based approaches

Pregnancy carries high medical and psychosocial risks that could lead pregnant women to experience serious health consequences. Providing protective measures for pregnant women is one of the critical tasks during the pregnancy period. This study proposes an emotion-based mechanism to detect the early stage of pregnancy using real-time data from Twitter. Pregnancy-related emotions (e.g., anger, fear, sadness, joy, and surprise) and polarity (positive and negative) were extracted from users' tweets using NRC Affect Intensity Lexicon and SentiStrength techniques. Then, pregnancy-related terms were extracted and mapped with pregnancy-related sentiments using part-of-speech tagging and association rules mining techniques. The results showed that pregnancy tweets contained high positivity, as well as significant amounts of joy, sadness, and fear. The classification results demonstrated the possibility of using users' sentiments for early-stage pregnancy recognition on microblogs. The proposed mechanism offers valuable insights to healthcare decision-makers, allowing them to develop a comprehensive understanding of users' health status based on social media posts.

Non-Hormonal Contraception

While hormonal contraceptives are efficacious and available in several forms for women, perception of safety and concern over side effects are a deterrent for many. Existing non-hormonal contraceptives include permanent sterilization, copper intrauterine devices (IUDs), chemical/physical barriers such as spermicides and condoms, as well as traditional family planning methods including withdrawal and the rhythm method. Individuals who wish to retain their fertility in the future can achieve highest adherence and efficacy with long-acting, reversible contraceptives (LARCs), though there is only one, the copper IUD, that is non-hormonal. As rates of unintended pregnancies remain high with existing contraceptive options, it is becoming increasingly attractive to develop novel pregnancy prevention methods for both women and men. Non-hormonal contraceptives can target a variety of critical reproductive processes discussed here. This review focuses on identified non-hormonal contraceptive targets and subsequent drug candidates in development.

Postpartum depression literacy in Chinese perinatal women: a cross-sectional study

Background

Postpartum depression literacy is a specific mental health literacy that can help perinatal women identify, manage, and prevent postpartum depression. However, the current status and associated factors of postpartum depression literacy among Chinese perinatal women are still unclear. This study investigated postpartum depression literacy and its associated factors among this group.

Methods

A cross-sectional survey was conducted involving 386 cases of perinatal women using the convenience sampling method. Participants completed four questionnaires to evaluate their general characteristics, postpartum depression literacy, perceived social support, and general self-efficacy. The SPSS 24.0 software was used for descriptive statistical analysis, univariate analysis, and multivariate analysis.

Results

The total PoDLiS score was (3.56 ± 0.32). The factors that composed the final multiple regression equation included planned pregnancy condition (β = -0.137, p = 0.003), education (β = 0.127, p < 0.001), history of depression (β = -0.271, p < 0.001), social support (β = 0.0012, p < 0.001), self-efficacy (β = 0.030, p < 0.001), and complications (β = -0.0191, p = 0.0019). They accounted for 32.8% of the total postpartum depression literacy variation (R² = 0.328, F = 24.518, p < 0.001).

Conclusion

The findings of this study improved our understanding of perinatal women's postpartum depression literacy and its associated factors. Women with low postpartum depression literacy urgently need to be identified. Comprehensive nursing intervention measures should be taken from six dimensions of mental health literacy, social support, and self-efficacy to improve the postpartum depression literacy of perinatal women.

Aberrant structural and functional alterations in postpartum depression: a combined voxel-based morphometry and resting-state functional connectivity study

Objectives

Postpartum depression (PPD) is a severe postpartum psychiatric disorder with unclear pathogenesis. Previous neuroimaging studies have reported structural or functional alterations in areas associated with emotion regulation, cognitive disorder, and parenting behaviors of PPD. The primary goal of this investigation was to explore the presence of brain structural alterations and relevant functional changes in PPD patients.

Methods

A total of 28 patients and 30 matched healthy postnatal women (HPW) underwent both three-dimensional T1-weighted magnetic resonance imaging (MRI) and resting-state functional MRI. Structural analysis was performed by voxel-based morphometry (VBM), followed by resting-state functional analysis using a seed-based whole-brain functional connectivity (FC) approach with abnormal gray matter volume (GMV) regions as seed.

Results

Compared with HPW, the PPD patients showed increased GMV in the left dorsolateral prefrontal cortex (DLPFC.L), the right precentral gyrus (PrCG.R), and the orbitofrontal cortex (OFC). In the PPD group, the DLPFC.L showed increased FC with the right anterior cingulate and paracingulate gyri (ACG.R) and the right middle frontal gyrus (MFG.R); the FC between the PrCG.R and the right median cingulate and paracingulate gyri (DCG.R) exhibited enhanced; the OFC showed increased FC with MFG.R and the left inferior occipital gyrus (IOG.L). In PPD, GMV of DLPFC.L was positively correlated with EDPS scores (r = 0.409 p = 0.031), and FC of PrCG.R-DCG.R was positively correlated with EDPS scores (r = 0.483 p = 0.020).

Conclusion

Structural and functional damage of the DLPFC.L and OFC is associated with cognitive disorders and parenting behaviors in PPD, while structural abnormalities of the DLPFC.L and PrCG.R are involved in impaired executive function. The increased GMV of DLPFC.L may be a unique structural pathological mechanism of PPD related to the inability of PPD patients to withstand long-term parenting stress. These findings have important implications for understanding neural mechanisms in PPD.

Unplanned pregnancy and the association with maternal health and pregnancy outcomes: A Swedish cohort study

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.

Analyzing the relationship between feelings about pregnancy and mother-infant bonding with the onset of maternal psychological distress after childbirth: The Japan Environment and Children's Study

BACKGROUND

Strengthening maternal mental health from early pregnancy is essential. This study investigated the factors affecting the onset of maternal psychological distress at 12 months after childbirth in women who had not experienced it during pregnancy.

METHODS

Feelings about pregnancy were assessed using a questionnaire in the first trimester, and maternal mental health was assessed using the 6-Item Kessler Psychological Distress Scale (K6) in the first and second/third trimesters and at 12 months after childbirth. Mother-infant bonding was assessed using the Japanese version of Mother-to-Infant Bonding Scale (MIBS-J) in the first, sixth, and twelfth months after childbirth. This study comprised 46,053 mothers without psychological distress (K6 ≤ 4) during pregnancy from the 97,415 mothers enrolled in the Japan Environment and Children's Study.

RESULTS

The onset of psychological distress at 12 months after childbirth was associated with negative maternal feelings about pregnancy, a history of infertility treatment before the current pregnancy, and poor mother-infant bonding after childbirth. Abortion history was not associated with psychological distress. The strongest factor affecting the onset of psychological distress was mother-infant bonding (β = 0.28), and the indirect effect of feelings about pregnancy was also observed (β = 0.10).

LIMITATIONS

We used the full version of MIBS-J consisting of 10 items at 12 months after childbirth but included only five items in the first and sixth months.

CONCLUSIONS

Inadequate mother-infant bonding was associated with the onset of maternal psychological distress after childbirth. Supporting mother-infant bonding is critical throughout the perinatal period, considering maternal feelings about pregnancy.

Partnering with recovery community centers to build recovery capital by improving access to reproductive health

BACKGROUND

People with substance use disorders (SUD), especially opioid use disorder (OUD) have the highest rates of unintended pregnancies (80-95%) and report unmet reproductive health needs. Women of childbearing age have some of the highest death rates from opioids and are notably rising the most rapidly, and when pregnancy does occur overdose is one of the leading causes of maternal mortality. There are numerous gender-based health disparities and social determinants of health shaped by the distribution of power and privilege that influence the risk trajectories of people who can get pregnant or are pregnant with a substance use disorder (SUD).

PURPOSE

The purpose of this paper is to describe how reproductive health is essential to recovery and building recovery capital for people who can get pregnant, (1) introduce a pilot implementation science study working with trained peer support coaches to promote reproductive autonomy in the community, and (2) make policy and advocacy recommendations relevant to the new reproductive health landscape in the United States. We will also describe the adaptation and feasibility of the initial pilot study where we partnered with a recovery community center to train peer recovery coaches to provide low barrier resources (contraception, pregnancy tests and prenatal vitamins) and referrals to health care.

METHODS

This initiative is the merging of best practices in recovery and community-based global reproductive health, to empower people with SUD who can get pregnant in an implementation science framework. The pilot study will last 3 months in each city and aims to (1) assess and describe the effectiveness of the training of local peer recovery coaches on the link between recovery capital and reproductive health, and (2) assess the feasibility, acceptability, appropriateness, scalability, sustainability, and uptake and reach of low barrier reproductive health resources (pregnancy tests, prenatal vitamins, and emergency contraception). In this paper we are only reporting the initial findings regarding adaptation and feasibility.

FINDINGS

Informed by qualitative interviews with stakeholders and participants, the method of contraception was adapted from injectable to emergency to meet the needs and context of the community with SUD. Early outcomes such as uptake and acceptability indicate that this is a feasible model with peer recovery coaches and recovery community centers, with the greatest uptake of emergency contraception and pregnancy tests.

CONCLUSION

Considering recent policies limiting access to reproductive health, innovative community-based solutions are needed to engage and empower people who can get pregnant or are pregnant while in active drug use and in recovery. Providing low barrier reproductive health items by people with lived experience with SUD can serve as a valuable harm reduction model and improve recovery capital.

CLINICAL RELEVANCE

This is the first study to propose a methodology and context to implement a community-based study merging best practices in recovery with those in reproductive health with the potential to improve recovery capital and maternal/child health trajectories for people with SUD.

Postpartum Depression in Young Mothers in Urban and Rural Indonesia

OBJECTIVES

Young mothers are vulnerable to postpartum depression due to role transition-related stress. Understanding the causes underlying these stressors is essential for developing effective interventions.

METHODS

This study analyzed the 2018 Indonesian Basic Health Research data. The Mini International Neuropsychiatric Interview was used to assess postpartum depression symptoms in mothers aged 15-24 years with infants aged 0-6 months. In 1285 subjects, the risk factors for postpartum depression were evaluated using multivariate logistic regression.

RESULTS

The overall prevalence of depression in the 6 months postpartum was 4.0%, with a higher prevalence in urban areas (5.7%) than in rural areas (2.9%). Urban and rural young mothers showed distinct postpartum depression risk factors. In urban areas, living without a husband (odds ratio [OR], 3.82; 95% confidence interval [CI], 1.24 to 11.76), experiencing preterm birth (OR, 4.67; 95% CI, 1.50 to 14.50), having pregnancy complications (OR, 3.03; 95% CI, 1.20 to 7.66), and having postpartum complications (OR, 5.23; 95% CI, 1.98 to 13.80) were associated with a higher risk of postpartum depression. In rural areas, postpartum depression was significantly associated with a smaller household size (OR, 3.22; 95% CI, 1.00 to 10.38), unwanted pregnancy (OR, 4.40; 95% CI, 1.15 to 16.86), and pregnancy complications (OR, 3.41; 95% CI, 1.31 to 8.88).

CONCLUSIONS

In both urban and rural contexts, postpartum depression relates to the availability of others to accompany young mothers throughout the postpartum period and offer support with reproductive issues. Support from the family and the healthcare system is essential to young mothers' mental health. The healthcare system needs to involve families to support young mothers' mental health from pregnancy until the postpartum period.

Understanding women's views of and preferences for accessing postpartum contraception: a qualitative evidence synthesis

BACKGROUND

Nearly half of women experience unintended pregnancies. These are associated with increased risk of poor maternal physical and psychosocial health outcomes. Many pregnancies in the first year postpartum are unintended, further increasing risks of poor outcomes and complications. We undertook a qualitative evidence synthesis to evaluate qualitative research on women's views and preferences for accessing postpartum contraception, and identify evidence gaps and opportunities for postpartum contraception provision.

METHODS

Five databases were searched to identify relevant qualitative studies. Included studies focused on views of, and preferences for, accessing postpartum contraception for women of reproductive age in high-income countries.

RESULTS

Of 1854 studies identified, 28 full texts were assessed and 19 studies included. These were critically appraised using Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) and analysed using thematic synthesis. Included studies indicated the majority of women desire postpartum contraception, but face a range of financial, health system and personal barriers. Women felt unclear about the ideal interpregnancy interval (IPI) and the rationale for this. Women preferred contraceptive counselling at varying times both antenatally and postnatally, and commonly preferred to receive contraception in the immediate postpartum period before hospital discharge. Women commonly saw their obstetrician or general practitioner for contraceptive counselling, but welcomed midwifery involvement.

CONCLUSIONS

Most women were interested in postpartum contraception and pregnancy spacing, but felt unclear about the optimal IPI, highlighting the need for further education and support around this issue. Contraceptive counselling was viewed as valuable antenatally and postnatally, and by varying maternal health providers, as was the provision of immediate postpartum contraception.

"ContraceptED": A Multidisciplinary Framework for Emergency Department-Initiated Contraception

Emergency departments (EDs) are common access points for patients who are at high risk for unintended pregnancy. Low-barrier access to effective contraception represents a crucial and low-cost intervention to address this public health need. Same-day initiation of contraception during an ED visit is a unique opportunity to provide reproductive health care for high-risk patients with otherwise limited health care access. We collaborated with our obstetrics and gynecology (OB/GYN) department, pharmacists, and a team of community health advocates to support emergency clinicians (namely, emergency physicians and advanced practice providers) in assessing pregnancy and contraceptive readiness, increasing proficiency in contraception counseling, prescribing hormonal contraception, counseling on barrier and emergency contraception, and inserting (and removing) the Nexplanon implant, a form of long-acting reversible contraception. With this novel approach, we found that emergency clinicians voluntarily participated in trainings on contraception, including low-threshold long-acting reversible contraception initiation; and, after completing these trainings, clinicians integrated these skills into their workflow in the ED. We report our results after screening 38 patients during our current Pilot Phase of implementing this program.

Selected Factors of Experiencing Pregnancy and Birth in Association with Postpartum Depression

BACKGROUND

The aim of the study is to analyse the risk of postpartum depression using dimensions of perceived support (information, emotional, and physical), antenatal education (satisfaction and attitude), and attitude toward pregnancy (wanted or unwanted).

METHODS

A cross-sectional study was carried out among 584 postpartum women in two university birth centres in Slovakia. The Edinburgh Postnatal Depression Scale (EPDS) score was used. Descriptive statistics and analysis of variance, as well as logistic regression, were employed in the study. Found associations were adjusted for education level, type of birth, psychiatric history, and age.

RESULTS

As many as 95.1% of women reported their pregnancy as being wanted. Antenatal education, particularly satisfaction with it, showed a negative association with the EPDS score level. No significant differences in depression levels were found considering attitude toward pregnancy and perceived support.

CONCLUSIONS

The study pointed out the significance of antenatal education to lower the risk of the postpartum depression. One of the important criteria of effective education is a woman's subjective satisfaction with it.

Unintended pregnancy and childhood maltreatment: The protective effect of positive relationships

BACKGROUND

Childhood maltreatment is associated with sexual risk-taking behaviors in adulthood but can also have generational effects on maternal/child health.

METHODS

This cross-sectional study examined the relationship between childhood abuse and neglect and unintended pregnancy, and then assessed the effect of relationship attributes on this outcome.

RESULTS

Findings indicate parenting women (n = 153) in long-term relationships who experienced childhood emotional abuse had higher scores of unintended pregnancies (p = .023). Yet women with moderate/high partner appraisal (perceptions of their partner's attributes used to assess interpersonal conflicts) showed no difference in unintended pregnancies between those with and without emotional abuse in childhood. Women with emotional abuse and low partner appraisal had higher unintended pregnancy scores (p = .002).

DISCUSSION/CONCLUSION

This study has implications for public health nursing and life course research demonstrating that a positive adult interpersonal environment can reduce the sequelae of adverse health outcomes associated with childhood emotional abuse. The results reinforce the importance of screening adults for childhood maltreatment to establish early risk for unintended pregnancy.

Maternal alcohol consumption and risk of postpartum depression: a meta-analysis of cohort studies

OBJECTIVES

The relationship between maternal alcohol consumption and postpartum depression (PPD) is still controversial. The objective of the present study was to assess the association between maternal alcohol consumption and the risk of developing PPD by means of a meta-analysis of cohort studies.

STUDY DESIGN

This was a meta-analysis.

METHODS

PubMed, Web of Science, Embase, Cochrane Library, China Biology Medicine disc, Chinese National Knowledge Infrastructure, Weipu, and Wanfang databases were searched up to February 4, 2021, to identify relevant studies that evaluated the association between maternal alcohol consumption and PPD. Meta-analysis was conducted using RevMan software and Stata software. Subgroup and sensitivity analyses were performed to explore the potential heterogeneity source, and Begg's funnel plots and Begg's linear regression test were conducted to assess the potential publication bias.

RESULTS

A total of 12 studies involving 50,377 participants were identified in our study. Overall, pregnant women who were exposed to alcohol were at a significantly greater risk of developing PPD compared with those who did not consume alcohol (odds ratio = 1.21; 95% confidence interval: 1.04-1.41; P = 0.020).

CONCLUSIONS

Maternal alcohol consumption is significantly associated with the risk of developing PPD. These results emphasize the necessity of enhancing health awareness, improving the public health policies and regulations concerning alcohol use, and strengthening the prevention and intervention of maternal alcohol consumption to promote maternal mental health.

Opportunities for Increasing Access to Effective Contraception in Australia

Effective contraception can prevent unintended pregnancies, however there is an unmet need for effective contraception in Australia. Despite their being a range of contraceptive methods available, access to these remains equitable and uptake of the most effective methods is low. There is an opportunity to reduce the rate of unintended pregnancies in Australia by improving the uptake of effective contraception for those who desire this. Improving access will require increasing consumer health literacy about contraception, as well as the option of telehealth as a mode of service delivery, and stronger investment in contraceptive services through appropriate reimbursement for providers. There is also a need to test new models of care to increase access to and use of effective contraception in Australia, including nurse and midwifery-led models of contraceptive care and pharmacy involvement in contraceptive counseling.

Clustering of characteristics associated with unplanned pregnancies: the generation R study

Background

Unplanned or unintended pregnancies form a major public health concern because they are associated with unfavorable birth outcomes as well as social adversity, stress and depression among parents-to-be. Several risk factors for unplanned pregnancies in women have previously been identified, but studies usually take a unidimensional approach by focusing on only one or few factors, disregarding the possibility that predictors might cluster. Furthermore, data on predictors in men are largely overlooked. The purpose of this study is to determine predictors of unplanned versus planned pregnancy, to determine predictors of ambivalent feelings regarding pregnancy, and to investigate how characteristics of men and women with an unplanned pregnancy cluster together.

Methods

This study was embedded in Generation R, a multiethnic population-based prospective cohort from fetal life onwards. Pregnancy intention was reported by 7702 women and 5367 partners. Information on demographic, mental, physical, social, and sexual characteristics was obtained. Logistic regression, multinomial regression and cluster analyses were performed to determine characteristics that were associated with an unplanned pregnancy, with ambivalent feelings regarding the unplanned pregnancy and the co-occurrence of characteristics in women and men with unplanned pregnancy.

Results

Twenty nine percent of the pregnancies were unplanned. Logistic regression analyses showed that 42 of 44 studied predictors were significantly associated with unplanned pregnancy. The most important predictors were young age, migration background, lower educational level, lower household income, financial difficulties, being single, lower cognitive ability, drug use prior to pregnancy, having multiple sexual partners in the year prior to the pregnancy, younger age of first sexual contact and a history of abortion. Multinomial regression analyses showed that a Turkish or Moroccan background, Islamic religion, little financial opportunities, being married, having ≥3 children, high educational level, more mental health and social problems and older age of first sexual contact were associated with prolonged ambivalent feelings regarding pregnancy. Different combinations of characteristics were observed in the four clusters of women and men with unplanned pregnancy.

Conclusions

Many predictors are related with unplanned pregnancies, ambivalent feelings toward the pregnancy, and we identified very heterogeneous groups of women and men with unplanned pregnancies. This calls for heterogeneous measures to prevent unplanned pregnancies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14342-y.

Risk factors of postpartum depression and depressive symptoms: umbrella review of current evidence from systematic reviews and meta-analyses of observational studies

BACKGROUND

Evidence on risk factors for postpartum depression (PPD) are fragmented and inconsistent.

AIMS

To assess the strength and credibility of evidence on risk factors of PPD, ranking them based on the umbrella review methodology.

METHOD

Databases were searched until 1 December 2020, for systematic reviews and meta-analyses of observational studies. Two reviewers assessed quality, credibility of associations according to umbrella review criteria (URC) and evidence certainty according to Grading of Recommendations-Assessment-Development-Evaluations criteria.

RESULTS

Including 185 observational studies (n = 3 272 093) from 11 systematic reviews, the association between premenstrual syndrome and PPD was the strongest (highly suggestive: odds ratio 2.20, 95%CI 1.81-2.68), followed by violent experiences (highly suggestive: odds ratio (OR) = 2.07, 95%CI 1.70-2.50) and unintended pregnancy (highly suggestive: OR=1.53, 95%CI 1.35-1.75). Following URC, the association was suggestive for Caesarean section (OR = 1.29, 95%CI 1.17-1.43), gestational diabetes (OR = 1.60, 95%CI 1.25-2.06) and 5-HTTPRL polymorphism (OR = 0.70, 95%CI 0.57-0.86); and weak for preterm delivery (OR = 2.12, 95%CI 1.43-3.14), anaemia during pregnancy (OR = 1.47, 95%CI 1.17-1.84), vitamin D deficiency (OR = 3.67, 95%CI 1.72-7.85) and postpartum anaemia (OR = 1.75, 95%CI 1.18-2.60). No significant associations were found for medically assisted conception and intra-labour epidural analgesia. No association was rated as 'convincing evidence'. According to GRADE, the certainty of the evidence was low for Caesarean section, preterm delivery, 5-HTTLPR polymorphism and anaemia during pregnancy, and 'very low' for remaining factors.

CONCLUSIONS

The most robust risk factors of PDD were premenstrual syndrome, violent experiences and unintended pregnancy. These results should be integrated in clinical algorithms to assess the risk of PPD.

Perinatal depression and its impact on infant outcomes and maternal-nurse SMS communication in a cohort of Kenyan women

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.

Availability and readiness of healthcare facilities and their effects on long-acting modern contraceptive use in Bangladesh: analysis of linked data

Aim

Increasing access to long-acting modern contraceptives (LMAC) is one of the key factors in preventing unintended pregnancy and protecting women’s health rights. However, the availability and accessibility of health facilities and their impacts on LAMC utilisation (implant, intrauterine devices, sterilisation) in low- and middle-income countries is an understudied topic. This study aimed to examine the association between the availability and readiness of health facilities and the use of LAMC in Bangladesh.

Methods

In this survey study, we linked the 2017/18 Bangladesh Demographic and Health Survey data with the 2017 Bangladesh Health Facility Survey data using the administrative-boundary linkage method. Mixed-effect multilevel logistic regressions were conducted. The sample comprised 10,938 married women of 15–49 years age range who were fertile but did not desire a child within 2 years of the date of survey. The outcome variable was the current use of LAMC (yes, no), and the explanatory variables were health facility-, individual-, household- and community-level factors.

Results

Nearly 34% of participants used LAMCs with significant variations across areas in Bangladesh. The average scores of the health facility management and health facility infrastructure were 0.79 and 0.83, respectively. Of the facilities where LAMCs were available, 69% of them were functional and ready to provide LAMCs to the respondents. The increase in scores for the management (adjusted odds ratio (aOR), 1.59; 95% CI, 1.21–2.42) and infrastructure (aOR, 1.44; 95% CI, 1.01–1.69) of health facilities was positively associated with the overall uptake of LAMC. For per unit increase in the availability and readiness scores to provide LAMC at the nearest health facilities, the aORs for women to report using LAMC were 2.16 (95% CI, 1.18–3.21) and 1.74 (95% CI, 1.15–3.20), respectively. A nearly 27% decline in the likelihood of LAMC uptake was observed for every kilometre increase in the average regional-level distance between women’s homes and the nearest health facilities.

Conclusion

The proximity of health facilities and their improved management, infrastructure, and readiness to provide LAMCs to women significantly increase their uptake. Policies and programs should prioritise improving health facility readiness to increase LAMC uptake.

A population-level data linkage study to explore the association between health facility level factors and unintended pregnancy in Bangladesh

The objective of this study was to investigate the effects of health facility-level factors, including the availability of long-acting modern contraceptives (LAMC) at the nearest health facility and its distance from women's homes, on the occurrence of unintended pregnancy that resulted in a live birth. We analysed the 2017/18 Bangladesh Demographic and Health Survey data linked with the 2017 Bangladesh Health Facility Survey. The weighted sample comprised 5051 women of reproductive age, who had at least one live birth within 3 years of the survey. The outcome variable was women's intention to conceive at their most recent pregnancy that ended with a live birth. The major explanatory variables were the health facility level factors. A multi-level multinomial logistic regression model was used to assess the association of the outcome variable with explanatory variables adjusting for individual, household, and community-level factors. Nearly 21% of the total respondents reported that their most recent live birth was unintended at conception. Better health facility management systems and health facility infrastructure were found to be 14-30% protective of unintended pregnancy that resulted in a live birth. LAMC availability at the nearest health facility was associated with a 31% reduction (95% CI 0.50-0.92) in the likelihood of an unwanted pregnancy that resulted in a live birth. Health facility readiness to provide LAMC was also associated with a 14-16% reduction in unintended pregnancies that ended with a birth. The likelihood of unintended pregnancy that resulted in a live birth increased around 20-22% with the increased distance of the nearest health facility providing LAMC from the women's homes.The availability of health facilities near women's homes and access to LAMC can significantly reduce unintended pregnancy. Policies and programs to ensure access and affordability of LAMC across current health facilities and to increase the number of health facilities are recommended.

Women's experience of unintended pregnancy and changes in contraceptive methods: evidence from a nationally representative survey

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.

Environmental risk factors, protective factors, and biomarkers for postpartum depressive symptoms: an umbrella review

We performed an umbrella review on environmental risk/protective factors and biomarkers for postpartum depressive symptoms to establish a hierarchy of evidence. We systematically searched PubMed, Embase, and the Cochrane Database of Systematic Reviews from inception until 12 January 2021. We included systematic reviews providing meta-analyses related to our research objectives. Methodological quality was assessed by AMSTAR 2, and the certainty of evidence was evaluated by GRADE. This review was registered in PROSPERO (CRD42021230784). We identified 30 articles, which included 45 environmental risk/protective factors (154,594 cases, 7,302,273 population) and 9 biomarkers (2018 cases, 16,757 population). The credibility of evidence was convincing (class I) for antenatal anxiety (OR 2.49, 1.91-3.25) and psychological violence (OR 1.93, 1.54-2.42); and highly suggestive (class II) for intimate partner violence experience (OR 2.86, 2.12-3.87), intimate partner violence during pregnancy (RR 2.81, 2.11-3.74), smoking during pregnancy (OR 2.39, 1.78-3.2), history of premenstrual syndrome (OR 2.2, 1.81-2.68), any type of violence experience (OR 2.04, 1.72-2.41), primiparity compared to multiparity (RR 1.76, 1.59-1.96), and unintended pregnancy (OR 1.53, 1.35-1.75).

Feasibility of continuous distal body temperature for passive, early pregnancy detection

Most American women become aware of pregnancy ~3-7 weeks after conceptive sex, and all must seek testing to confirm their pregnant status. The delay between conceptive sex and pregnancy awareness is often a time in which contraindicated behaviors take place. However, there is long standing evidence that passive, early pregnancy detection may be possible using body temperature. To address this possibility, we analyzed 30 individuals' continuous distal body temperature (DBT) in the 180 days surrounding self-reported conceptive sex in comparison to self-reported pregnancy confirmation. Features of DBT nightly maxima changed rapidly following conceptive sex, reaching uniquely elevated values after a median of 5.5 ± 3.5 days, whereas individuals reported a positive pregnancy test result at a median of 14.5 ± 4.2 days. Together, we were able to generate a retrospective, hypothetical alert a median of 9 ± 3.9 days prior to the date at which individuals received a positive pregnancy test. Continuous temperature-derived features can provide early, passive indication of pregnancy onset. We propose these features for testing and refinement in clinical settings, and for exploration in large, diverse cohorts. The development of pregnancy detection using DBT may reduce the delay from conception to awareness and increase the agency of pregnant individuals.

Gestational weight gain and risk of postpartum depression: A meta-analysis of observational studies

The association between gestational weight gain (GWG) and postpartum depression (PPD) is still controversial. The present study aimed to assess the association between GWG and the risk of developing PPD by means of a meta-analysis. PubMed, Web of Science, Embase, Cochrane Library, China Biology Medicine disk, Chinese National Knowledge Infrastructure, Weipu, and Wanfang database were searched up to May 19, 2021 to identify relevant studies that evaluated the association between GWG and PPD. Meta-analysis was conducted by using RevMan software and Stata software. Subgroup and sensitivity analyses were carried out to explore the potential heterogeneity source, and Begg's funnel plots and Begg's linear regression test were performed to assess the potential publication bias. A total of sixteen studies involving 100,438 participants were identified in this study. Overall, the total, excessive and inadequate GWG was significantly associated with a higher risk of developing PPD. These results emphasize the necessity of strengthening the prevention and intervention of excessive and inadequate weight gain during pregnancy to promote maternal and infant health. However, further studies on the association between GWG at different stages of pregnancy and the risk of developing PPD are warranted.

Exploring rise of pregnancy in Bangladesh resulting from contraceptive failure

The objective of this study was to determine how changes in pre-pregnancy contraceptive methods used between 2011 and 2017/18 contributed to the changes in pregnancy resulting from contraceptive methods failure in Bangladesh. We used 2011 and 2017/18 Bangladesh Demographic and Health Survey data. Pre-pregnancy contraceptive methods failure was our outcome of interest, which was determined using women's response about whether they became pregnant while using contraceptives before the most recent pregnancy. The year of the survey was the main explanatory variable. Descriptive statistics were used to describe the characteristics of the respondents. The difference in contraceptive methods failure across the socio-demographic characteristics was assessed by Chi-squared test. Multilevel poison regressions were used to determine the changes in the prevalence ratio of contraceptive methods failure across the survey years. Contraceptive methods failure rate increased between the surveys, from 22.8% in 2011 to 27.3% in 2017/18. Also, male condom use increased by 2.8%, while withdrawal/periodic abstinence and/or other methods decreased by 2.9%. The failure rates in these two categories of contraceptive methods increased substantially by 4.0% and 9.0%, respectively. Compared to the 2011 survey, the prevalence ratio (PR) of contraceptive methods failure was 20% (PR 1.2, 95% CI 1.1-1.3) high in the 2017/18 survey. This PR declined 13% (PR 1.1, 95% CI 1.04-1.2) once the model was adjusted for women's and their partner's characteristics along with the last contraceptives used. This study provides evidence of increasing rates of pregnancy due to contraceptive failure in Bangladesh. Given that this type of pregnancy is known to cause adverse pregnancy outcomes, including abortion, pregnancy complications, maternal and early child morbidity and mortality, policy and programs are needed to reduce its prevalence. Effective coordination between the contraception providers at the healthcare facilities and the households and a proactive role of family planning workers to make couples aware of the effective use of contraceptives are recommended.

Predictors of postpartum depression among Chinese mothers and fathers in the early postnatal period: A cross-sectional study

OBJECTIVE

Postpartum depression is a serious mental health problem in early parenthood. The prevalence of postpartum depression is currently increasing. However, no studies have yet examined and compared maternal and paternal psychological health during the early postpartum period. The objectives of this study were therefore to explore the prevalence of postpartum depression and identify its predictors among Chinese mothers and fathers in the early postpartum period.

DESIGN

A cross-sectional study was conducted from September 24, 2020 to April 7, 2021 in Guangzhou, China.

SETTING

A regional teaching hospital in Guangzhou, China, with approximately 3000 births per year.

PARTICIPANTS

Four hundred and fifty-four married couples in the 2, 3 days postpartum period following a singleton, full-term birth.

MEASUREMENTS AND FINDINGS

Participants completed the Edinburgh Postnatal Depression Scale, Parenting Satisfaction Subscale and Parenting Efficacy Subscale, Social Support Rating Scale, and the demographic and obstetric datasheet. The prevalence of depressive symptoms (Edinburgh Postnatal Depression Scale score ≥ 13) was 13.0% and 7.5% in mothers and fathers, respectively, in the early postpartum period. The predictors of maternal depression were maternal parenting satisfaction, paternal depression, maternal social support and maternal relationship with mother-in-law (adjusted R²= 0.34, F = 58.40, df = [4, 449], P < 0.001). While the predictors of paternal depression were paternal parenting satisfaction and self-efficacy, maternal depression and whether the pregnancy was planned (adjusted R²= 0.28, F = 44.85, df = [4, 449], P < 0.001).

KEY CONCLUSIONS

Maternal and paternal depression were positively correlated and were predictive factors for one another.

IMPLICATIONS FOR PRACTICE

Healthcare professionals should screen both mothers and fathers for depression in the early postpartum period and provide targeted support during time in hospital following birth. In addition, the focus of future interventions should be on both parents rather than just mothers.

COVID-19 and family planning service delivery: Findings from a survey of U.S. physicians

Equitable access to contraception is critical for reproductive autonomy. Using cross-sectional data from the DocStyles survey administered September-October 2020 (68% response rate), we compared changes in family planning-related clinical services and healthcare delivery strategies before and during the COVID-19 pandemic and assessed service provision issues among 1063 U.S. physicians whose practice provided family planning services just before the pandemic. About one-fifth of those whose practices provided the following services or strategies just before the pandemic discontinued these services during the pandemic: long-acting reversible contraception (LARC) placement (16%); LARC removal (17%); providing or prescribing emergency contraceptive pills (ECPs) in advance (18%); and reminding patients about contraception injections or LARC removal or replacement (20%). Many practices not providing the following services or strategies just before the pandemic initiated these services during the pandemic: telehealth for contraception initiation (43%); telehealth for contraception continuation (48%); and renewing contraception prescriptions without requiring an office visit (36%). While a smaller proportion of physicians reported service provision issues in the month before survey completion than at any point during the pandemic, about one-third still reported fewer adult females seeking care (37%) and technical challenges with telehealth (32%). Discontinuation of key family planning services during the COVID-19 pandemic may limit contraception access and impede reproductive autonomy. Implementing healthcare service delivery strategies that reduce the need for in-person visits (e.g., telehealth for contraception, providing or prescribing ECPs in advance) may decrease disruptions in care. Resources exist for public health and clinical efforts to ensure contraception access during the pandemic.