Physical health after childbirth and maternal depression in the first 12 months post partum: Results of an Australian nulliparous pregnancy cohort study

Prevalence of mental disorders among Australian females: Comparison according to motherhood status using Australian birth cohort data

PURPOSE

Studies examining mental disorders among women have primarily focused on either depression, anxiety, or substance use disorders and not included the broader spectrum of mental disorders. Mixed evidence exists on the prevalence rates of mental disorders among mothers. This study compares the prevalence of different mental disorders and mental comorbidities between mothers and non-mothers and assesses correlates of mental disorders among mothers.

METHODS

A population-based birth cohort design was adopted, consisting of 40,416 females born in Queensland, Australia, in 1983/84. Linked administrative data from hospital admissions were used to identify mental disorders. Cumulative incidence curves of different mental disorders were created separately for mothers and non-mothers.

RESULTS

Mental disorder prevalence among females by age 29-31 years was 7.8% (11.0% for mothers and 5.2% for non-mothers). Mothers were overrepresented in almost all categories of mental disorders, with overrepresentation becoming more pronounced with age. Mothers with a mental disorder were more likely to be unmarried, Indigenous, young at birth of first child, have greater disadvantage, and have a single child, compared to mothers without a mental disorder. Nearly half of the mothers (46.9%) had received a mental disorder diagnosis before having their first child.

CONCLUSIONS

Mothers, particularly unmarried, Indigenous, having greater disadvantage, and younger at birth of first child, represent a unique group with high vulnerability to mental disorders, that begins in childhood and is amplified with age. Presence of significant mental disorder comorbidities among females highlights the critical importance of a comprehensive, integrated approach to prevent and address multiple comorbidities.

Urinary incontinence increases risk of postpartum depression: systematic review and meta-analysis

OBJECTIVE

Postpartum depression is one of the most common complications after childbearing. Urinary incontinence is a frequent symptom during pregnancy and the postnatal period, often being the first time that women experience it. This systematic review and meta-analysis aimed to synthesize the evidence on the association between urinary incontinence and postpartum depression and to assess whether this association becomes weaker at 6 months after childbirth.

DATA SOURCES

MEDLINE, Embase, Cochrane Library, Web of Science, and PsycINFO were searched from inception to December 26, 2023.

STUDY ELIGIBILITY CRITERIA

Cross-sectional and cohort studies addressing the association between urinary incontinence and postpartum depression were included.

METHODS

Pooled odds ratios and their 95% confidence intervals, and 95% prediction intervals were estimated using a DerSimonian and Laird random-effects model for the association between urinary incontinence and postpartum depression. Subgroup analyses were conducted on the basis of time after delivery (<6 or ≥6 months). The risk of bias was assessed with the National Institutes of Health Quality Assessment Tool for Observational Cohort Studies.

RESULTS

Eleven published studies were included in the systematic review and meta-analysis. Overall, the odds ratio for the association between urinary incontinence and postpartum depression was 1.45 (95% confidence interval, 1.11-1.79; 95% prediction interval, 0.49-2.40; I2=65.9%; P=.001). For the 7 cohort studies, the odds ratio was 1.63 (95% confidence interval, 1.35-1.91; 95% prediction interval, 1.14-2.13; I2=11.1%; P=.345). For the 4 cross-sectional studies, the odds ratio was 1.05 (95% confidence interval, 1.04-1.05; 95% prediction interval, 1.04-1.06; I2=0.0%; P=.413). According to the time after delivery, the odds ratio estimates for cohort studies with a postpartum period <6 months were 1.44 (95% confidence interval, 1.07-1.81; prediction interval, 0.63-2.25; I2=0.0%; P=.603) and 1.53 (95% confidence interval, 1.16-1.89; prediction interval, 0.41-2.65; I2=50.7%; P=.087) for those with a postpartum period ≥6 months.

CONCLUSION

This systematic review and meta-analysis suggests that urinary incontinence may be a potential predictor of postpartum depression. Thus, it is important that health care professionals offer support and treatment options to women who experience these conditions.

Postpartum pain and the risk of postpartum depression: A meta-analysis of observational studies

OBJECTIVE

This meta-analysis of observational studies aimed to derive a more precise estimation of the relationship between postpartum pain and postpartum depression (PPD).

METHODS

A systematic literature search was completed in the following databases from inception to September 26, 2022: PubMed, Embase, and Web of Science. Quality evaluation of each study was achieved through Newcastle-Ottawa scale (NOS) assessment. Heterogeneity across studies was evaluated by Cochran's Q test and I2 test. Pooled estimates of odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were analyzed using fixed-effects model or random-effects model, according to heterogeneity. Subgroup analysis, sensitivity analysis, and Egger's test were also performed.

RESULTS

From the identified 1884 articles, a total of 8 studies involving 3973 participants were included in the final meta-analysis. Seven of the 8 studies were evaluated as high-quality, with NOS scores ≥7. A significant heterogeneity was observed (I2  = 66.5%, p = 0.004) among eight studies. Therefore, the performed random-effect model suggested a significant association between postpartum pain and PPD risk (OR 1.29, 95% CI 1.10-1.52, p = 0.002). However, the subgroup analyses did not define the source of heterogeneity. Moreover, the sensitivity analysis showed the stability of the pooled results, but the significant publication bias was identified (p = 0.009). The trim and fill method was performed and resulted in an OR of 1.14 (95% CI 0.95-1.37, p = 0.162).

CONCLUSIONS

This meta-analysis found a potential association between postpartum pain and PPD. Further researches are needed to provide more robust evidences.

Impact of a private sector residential early parenting program on clinically significant postnatal depressive symptoms experienced by women: Audit of routinely collected data

INTRODUCTION

Early parenting services in Australia offer brief structured residential programs to address moderate to severe non-psychotic mental health problems among women and unsettled infant/toddler behaviours. The aims were to (1) estimate the immediate and medium-term impact of a five-night psychoeducational residential early parenting program on postpartum depressive symptoms and (2) identify the factors associated with improvement or worsening of postpartum depressive symptoms after completing the program and six weeks post-discharge.

METHODS

Audit of routinely collected medical record data from pre-admission, pre-discharge and post-discharge assessments of a consecutive cohort of women admitted, with their infants/toddlers in a 15-month period to Masada Private Hospital Early Parenting Centre. Data included structured questions assessing: demographic characteristics, access to family and social support, past and current mental health problems, reproductive and obstetric health, chronic health conditions, breastfeeding problems, coincidental major life events, health risk behaviours and infant/toddler feeding, sleeping and crying behaviours. Standardised instruments included the Partner Interaction after Birth Scale (PIBS), the MacLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), Modified Fatigue Assessment Scale (FAS) and selected items from the Karitane Parenting Confidence Scale. The primary outcomes were Edinburgh Postnatal Depression Scale scores at pre-discharge and follow up assessments. Data were analysed using multinomial logistic regression models in which individual and psychosocial characteristics at pre-admission were included as predictors of the likelihood of the changes of the outcomes from pre-admission to pre-discharge and follow up.

RESULTS

Complete data from 1220 of 1290 (95%) eligible women were available to assess pre-admission to pre-discharge and from 559 (45.8%) to assess pre-discharge to six-week follow-up changes. The mean pre-admission EPDS score was 11.7 (95% CI: 11.5; 12.0), pre-discharge it was 7.1 (95% CI: 6.9; 7.4) and at six-week follow up it was 5.7 (95% CI: 5.3; 6.1). We found that almost all women experienced a clinically meaningful and rapid improvement in depressive symptoms of at least this magnitude (reduction in mean EPDS scores of 4.6 points from pre-admission to pre-discharge (five nights) and a further reduction of 1.2 points pre-discharge to follow up) (six weeks) and we identified an interpretable set of risk factors for symptoms that did not improve or worsened. The adverse outcomes were associated with having symptoms of borderline personality disorder, a partner experienced as lacking kindness and care, coincidental adverse events and having a child younger than six months.

CONCLUSION

Residential early parenting programs, which take a psycho-educational approach to strengthening caregiving skills, maximising agency, and reducing helplessness, have a rapid beneficial effect on women's postpartum depressive symptoms. These programs provide a valuable and effective component of comprehensive mental health services. Long-term dialectical behaviour therapy is indicated for women with borderline personality disorder traits for whom early parenting programs alone are insufficient to improve depressive symptoms.

Associations of pelvic floor dysfunction and postnatal mental health: a systematic review

BACKGROUND

Postpartum mental health conditions are common and can have devastating effects for both mother and infant. Adverse birth outcomes increase the risk of postnatal mental health conditions. Pelvic floor dysfunction (PFD) is a common adverse pregnancy outcome that may be a risk factor for postnatal mental health conditions. There are many studies reporting associations between PFD and postnatal mental health conditions, but no reports have synthesised the current literature as it relates to pregnancy and the postpartum period.

METHODS

A research librarian conducted systematic literature searches using terms concerning PFD, postnatal mental health conditions, and pregnancy. Searches were conducted within PubMed, Embase, CINAHL, Cochrane, and Scopus. Two reviewers independently rated each study for inclusion and study quality. No studies were excluded based on quality.

RESULTS

A total of 47 studies were included for review. Articles addressed sexual dysfunction (n = 11), incontinence (n = 21), perineal laceration (n = 13), pelvic organ prolapse (n = 2), and general pelvic floor symptoms (n = 2) and associations with postnatal mental health conditions. Two articles addressed more than one type of PFD. The majority (44 studies) reported associations between PFD and adverse postnatal mental health conditions.

DISCUSSION

Most studies included for review found consistent associations between PFD and adverse mental health conditions. Healthcare providers should screen for PFD and postnatal mental health conditions early in the postpartum period. Future research should investigate whether the treatment of PFD can modify the associations between PFD and postnatal mental health conditions.

Common maternal health problems and their correlates in early post-partum mothers

BACKGROUND

Mothers experience a wide range of maternal health problems after childbirth, which in turn, affect their well-being and ability to care for their newborn. These problems may be influenced by factors such as mode of delivery or socio-economic status.

OBJECTIVE

This study aims to investigate the prevalence of common maternal health problems and their correlates in a public primary healthcare institution in Singapore.

DESIGN

This was a cross-sectional study, based on a self-administered questionnaire.

METHODS

A total of 373 mothers (mean age 31.9 years) who accompanied their infants for their 4- to 8-week development assessments at a public primary care clinic in Singapore completed a self-administered questionnaire from June 2021 to December 2021. The questionnaire assessed demographic factors, mode of delivery, number of children, number of individuals providing significant help, and the frequency of common physical and mental maternal health problems using a 5-point Likert-type scale.

RESULTS

The five most common maternal health problems were fatigue (77.7%), lower back pain (59.3%), Caesarean wound pain (54.3%), upper back pain (53.0%) and vaginal pain (41.2%). The prevalence of depression and anxiety was 22.0% and 11.3%, respectively. With respect to the symptoms' correlates, pain on passing urine was more frequent after assisted vaginal deliveries than all other forms of deliveries (all pairwise p < 0.01), and pain on passing motion was more frequent in vaginal deliveries than in Caesarean deliveries (all pairwise p < 0.05). Mothers having a larger number of children more frequently experienced headaches (β = 0.17, SE = 0.05, p = 0.002) and less frequently experienced breastfeeding difficulties (β = -0.28, SE = 0.08, p < 0.001).

CONCLUSION

Mothers experienced a high prevalence of maternal health problems in multiple domains during the first 8 weeks after childbirth. Mode of delivery and number of children were associated with increased prevalence of certain problems. Mothers' physical and mental well-being should be investigated early after delivery and addressed with adequate treatments and resources.

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.

The relationship between perineal trauma and postpartum psychological outcomes: a secondary analysis of a population-based survey

BACKGROUND

Perineal trauma, involving either naturally occurring tears or episiotomy, is common during childbirth but little is known about its psychological impact. This study aimed to determine the associations between childbirth related perineal trauma and psychological outcomes reported by women three months after giving birth and to explore factors that could mediate relationships between perineal trauma and maternal psychological outcomes.

METHODS

This study was a secondary analysis of data from a cross-sectional population-based survey of maternal and infant health. A total of 4,578 women responded to the survey, of which 3,307 had a vaginal birth and were eligible for inclusion into the analysis. Symptoms of depression, anxiety, and post-traumatic stress (PTS) symptoms were assessed using validated self- report measures. Physical symptoms were derived from a checklist and combined to produce a composite physical symptoms score. Regression models were fitted to explore the associations.

RESULTS

Nearly three quarters of women experienced some degree of perineal trauma. Women who experienced perineal trauma reported having more postnatal physical symptoms (adjusted proportional odds ratio 1.47, 95%CI 1.38 to 1.57, p-value < 0.001), were more likely to report PTS symptoms (adjusted OR 1.19, 95%CI 1.04 to 1.36, p-value 0.010), and there was strong evidence that each unit increase in the physical symptoms score was associated with between 38 and 90% increased adjusted odds of adverse psychological symptoms. There was no evidence of association between perineal trauma and satisfaction with postnatal care, although there was strong evidence that satisfaction with labour and birth was associated with 16% reduced adjusted odds of depression and 30% reduced adjusted odds of PTS symptoms.

CONCLUSIONS

Women who experienced perineal trauma were more likely to experience physical symptoms, and the more physical symptoms a woman experienced the more likely she was to report having postnatal depression, anxiety and PTS symptoms. There was some evidence of a direct association between perineal trauma and PTS symptoms but no evidence of a direct association between perineal trauma and depression or anxiety. Assessment and management of physical symptoms in the postnatal period may play an important role in reducing both physical and psychological postnatal morbidity.

Urinary incontinence in the postpartum 1-year period: Its prevalence and effect on psychosocial status of women

OBJECTIVES

In this study, it was aimed to determine the prevalence and effect of urinary incontinence in the postpartum 1 year period on psychosocial status of women.

METHODS

This study with a cross-sectional and descriptive design was conducted between 01.10.2021 and 01.04.2022. There were 406 women in the postpartum 8 weeks to 1 year period who participated in the study. The data were collected through Identifying Information Form, Edinburgh Postnatal Depression Scale, and Nottingham Health Profile.

RESULTS

In the study, it was determined that 21.9% of the women in the postpartum period experienced urinary incontinence problems, and that the most common type of incontinence experienced was stress incontinence (62.9%). Edinburgh Postnatal Depression Scale mean score of the women who experienced urinary incontinence problems in the postpartum period was found to be significantly higher compared to those who did not experience this problem (P < .05), but no significant difference was found between the rates of those with depression risk according to the cutoff point of the scale (≥13 points). As a result of the regression analysis, it was determined that the increase in depression risk resulted not from urinary incontinence but from age and parity. It was also determined that the mean scores of the women who experienced incontinence problems from the subscales of Nottingham Health profile was significantly high (P < .05).

CONCLUSIONS

In conclusion, urinary incontinence in the postpartum period is a prevalent problem affecting approximately one-fifth of women. In addition, this problem negatively affects the psychological and social dimensions of women's health.

Depression Level and Its Associated Factors among Postpartum Working Women in Kuching, Sarawak-A Cross-Sectional Study

Background

Postpartum depression (PD) among women, if left untreated, may result in long-term health and social consequences for them and their families. This cross-sectional study aimed to determine the factors contributing to PD among working mothers in Kuching, Sarawak, Malaysia.

Methods

Systematic sampling was used to recruit working mothers who attended Kuching's maternal and child health clinics. They were interviewed with a validated translated questionnaire to obtain data on sociodemographics, health profiles, and Edinburgh Postnatal Depression Scale (EPDS) and postpartum symptoms. Data were analysed using IBM SPSS version 21.0.

Results

Out of the total 281 respondents, 15.3% of respondents had depression symptoms. Fatigue (42.7%), back or neck pain (36.3%), breast discomfort (16.4%), dizziness (13.5%) and nipple irritation (11.0%) were the most common physical symptoms experienced by the mothers. Regression analysis showed that working mothers who exhibited higher scores of physical symptoms were 1.26 times more likely to develop PD (adjusted odd ratio 1.26, P < 0.01; 95% CI: 1.071, 1.487).

Conclusion

Physical symptoms were the predictors of PD among working mothers.

Mental health penalties of having a child: findings from the China family panel studies

In recent years, the birth rate in China has rapidly declined. While much research has been done on the penalties in earnings that women incur when they fall behind men in the labor market due to childbirth, there has been little to no research on the mental health effects. This study addresses the gap in current literature by examining the mental health penalties that women experience after having a child in comparison to men. We applied econometric modeling to data collected from China Family Panel Studies (CFPS) and found that women experienced a significant, immediate, and long-run decline (4.3%) in life satisfaction after their first child, while men were unaffected. We also found that women experienced a significant increase in depression after their first child. This suggests mental health penalties since the mental health risk proxied by these two measurements is only significant for women. This is likely related to child penalties in labor market performance and childbirth-related physical health issues. When countries adopt multiple tools to stimulate the birth rate for economic growth, they must consider the implicit burden on women-especially the long-term negative effects on mental health.

Support during the postnatal period: Evaluating new mothers' and midwives' experiences of a new, coordinated postnatal care model in a midwifery clinic in Sweden

OBJECTIVE

Continuity of care as provided by midwives promoting the health and well-being of new mothers during the postnatal period is critical; thus, access to midwifery services needs to be facilitated. The aim of this study was to describe new mothers' and midwives' experiences and perceptions of a new coordinated postnatal care intervention in a midwifery clinic.

DESIGN

New mothers responded to open-ended questions in a survey, and midwives were interviewed individually about the intervention. A deductive content analysis research related to continuity of care concepts was used.

SETTING AND PARTICIPANTS

The study was carried out at a midwifery clinic in a larger city in Sweden, for an eight-month period in 2019 and 2020. Two hundred and sixteen answers from new mothers and nine interviews with midwives were analysed.

INTERVENTION

All registered pregnant women at the midwifery clinic received enhanced postnatal support based on a new coordinated postnatal care model. The focus was on continuity of care, from pregnancy to the postnatal period and included planning for the first weeks after childbirth at the end of pregnancy, early postnatal contact and several visits to the midwifery clinic.

FINDINGS

New mothers describing the coordinated postnatal care model highlighted continuity and accessibility as empowering factors that made them feel assured and confident. Midwives emphasised the pregnancy to postnatal continuity as crucial to providing care based on individual needs.

KEY CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Using a structured and coordinated care model as a midwife that includes planning for the postnatal period together with the pregnant woman at the end of pregnancy may be a good and relatively easy way to create continuity and thus ensure satisfaction and confidence in expectant and new mothers.

Do Improvements in Maternal Mental Health Predict Improvements in Parenting? Mechanisms of the Mindful with Your Baby Training

Postpartum mental health symptoms are associated with parenting difficulties, which have negative consequences for child development. Interventions for young mothers should target their mental health problems and parenting difficulties. Mindful with Your Baby (MwyB) is an intervention for parents, with a baby, who experience (mental) health problems and/or stress or insecurity in parenting. This study seeks to replicate previous effects of MwyB regarding mindfulness, mindful parenting, maternal (mental) health (psychological distress, depressive mood, physical health complaints) and parenting outcomes (parenting stress, parental self-efficacy, bonding), and gain insight into the working mechanisms of the training. Mothers with babies aged 1–18 months (n = 61) completed questionnaires at waitlist, pretest, posttest, and 8-week follow-up. No significant differences were seen between the waitlist and pretest. Significant improvements in all outcomes were shown in the posttest (except for physical health complaints) and follow-up, compared to the pretest. Improvements in depressive symptoms and physical health complaints were dependent on improvements in mindfulness. Improvements in parental self-efficacy were dependent on improvements in mindful parenting. Improvements in some (mental) health and parenting outcomes seemed to be bidirectional. The results suggest that both mindfulness and mindful parenting are important for mothers who experience psychological distress and/or stress or insecurity in parenting their babies.

Characteristics and co-admissions of mothers and babies admitted to residential parenting services in the year following birth in NSW: a linked population data study (2000-2012)

Background

There is a tiered healthcare system in Australia to support maternal and child health, including, non-psychiatric day stay and residential parenting services (RPS) such as Tresillian and Karitane (in New South Wales [NSW]). RPS are unique to Australia, and currently there is limited information regarding the healthcare trajectory of women accessing RPS and if they are more likely to have admissions to other health facilities within the first-year post-birth. This study aimed to examine differences in hospital co-admissions for women and babies admitted to RPS in NSW in the year following birth compared to non-RPS admitted women.

Methods

A linked population data study of all women giving birth in NSW 2000–2012. Statistical differences were calculated using chi-square and student t-tests.

Results

Over the 12-year timeframe, 32,071 women and 33,035 babies were admitted to RPS, with 5191 of these women also having one or more hospital admissions (7607 admissions). The comparator group comprised of 99,242 women not admitted to RPS but having hospital admissions over the same timeframe (136,771 admissions). Statistically significant differences between cohorts were observed for the following parameters (p ≤ .001). Based upon calculated percentages, women who were admitted to RPS were more often older, Australian born, socially advantaged, private patients, and having their first baby. RPS admitted women also had more multiple births and labour and birth interventions (induction, instrumental birth, caesarean section, epidural, episiotomy). Their infants were also more often male and admitted to Special Care Nursery/Neonatal Intensive Care. Additionally, RPS admitted women had more admissions for mental health and behavioural disorders, which appeared to increase over time. There was no statistical difference between cohorts regarding the number of women admitted to a psychiatric facility; however, women attending RPS were more likely to have mood affective, or behavioural and personality disorder diagnoses.

Conclusion

Women accessing RPS in the year post-birth were more socially advantaged, had higher birth intervention and more co-admissions and treatment for mental health disorders than those not accessing RPS. More research is needed into the impact of birth intervention and mental health issues on subsequent parenting difficulties.

Supporting early infant relationships and reducing maternal distress with the Newborn Behavioral Observations: A randomized controlled effectiveness trial

Research points to the significant impact of maternal distress on the parent‐infant relationship and infant development. The Newborn Behavioral Observations (NBO) is a brief intervention supporting the infant, the parent and their relationship. This randomized controlled trial examined the effectiveness of the NBO in a population with antenatal distress and risk of postnatal depression (PND). Pregnant, first‐time mothers with current anxiety or depression symptoms or past mental illness were recruited from two Australian hospitals. Participants received three NBO sessions in the first month of life plus treatment as usual (TAU), or, TAU‐only. Outcomes assessed at infant age 4 months included mother‐infant interaction quality; maternal anxiety and depression symptoms; and depression diagnosis. Of 111 pregnant individuals randomized, 90 remained eligible and 74 completed the trial (82.2% retention). There were intervention effects on emotional availability F(6, 67) = 2.52, p = .049, Cohen's d = .90, with higher sensitivity and non‐intrusiveness in the intervention group (n = 40) than the comparison group (n = 34). There was an intervention effect approaching significance for anxiety symptoms at 4 months (p = .06), and a significant effect over time (p = .014), but not for depression symptoms. Anxiety and depression symptoms significantly reduced to sub‐clinical levels within the intervention group only. There were fewer depression diagnoses (n = 6) than expected across groups, with no observed intervention effect. No adverse intervention effects were seen. Exploratory analysis of sensory processing sensitivity suggested differential susceptibility to distress and intervention benefits. The NBO was accepted and exerted meaningful effects on relationship quality and distress; and may enhance the infant's interaction experience and maternal emotional adjustment in at‐risk populations.

The physical and emotional health of South Korean mothers of preterm infants in the early postpartum period: a descriptive correlational study

Purpose

This study investigated the physical and emotional health of South Korean mothers of preterm infants in the early postpartum period.

Methods

In this descriptive correlational study, the participants included 91 mothers of preterm infants who were admitted to the neonatal intensive care unit of a tertiary hospital in South Korea. Physical health status was measured using a self-reported questionnaire, postpartum depression using the Edinburgh Postnatal Depression Scale, anxiety using the State-Trait Anxiety Inventory, and guilt using a 4-item scale.

Results

Fatigue had the highest score among mothers' physical health problems, followed by shoulder pain, nipple pain, neck pain. The average postpartum depression score was 11.02 points, and 44% of women had postpartum depression with a score of 12 or above. Postpartum depression significantly was correlated with physical health (r=.35, p=.001), anxiety (r=.84, p<.001), and guilt (r=.75, p<.001) and was significantly higher for women with multiple births, and preterm infants who required ventilator and antibiotic treatment. Anxiety also showed a significant difference according to preterm infants’ condition.

Conclusion

The significant correlations between postpartum depression and physical health, anxiety, and guilt indicate a need for nursing interventions that provide integrated management of mothers’ physical and emotional health.

Perinatal Depression in Australian Women during the COVID-19 Pandemic: The Birth in the Time of COVID-19 (BITTOC) Study

The COVID-19 pandemic has impacted perinatal mental health globally. We determined the maternal factors and pandemic-related experiences associated with clinically significant perinatal (pregnant and post-partum) depressive symptoms in Australian women. Participants (n = 2638; pregnant n = 1219, postnatal n = 1419) completed an online survey (August 2020 through February 2021) and self-reported on depression, social support, and COVID-19 related experiences. We found elevated depressive symptoms amongst 26.5% (pregnant) and 19% (postnatal) women. Multiple logistic regression analyses showed higher likelihood of elevated depression associated with residence in Victoria, lower education, past/current mental health problems, greater non-pandemic prenatal stress, age ≥ 35 years (pregnant women) and existing physical health issues or disability in self or others (postnatal women). Greater family stress/discord and lower social support (friends) was associated with higher odds of elevated perinatal depression, while lower social support (family) was significantly associated with elevated depressive symptoms in pregnant women. Greater depression was associated with social distancing, pandemic-related news exposure and changes to prenatal care (pregnant women). Single postnatal women showed lower odds of elevated depression than partnered women. Our findings underscore the importance of universal screening for depression and targeted support during a pandemic for perinatal women displaying vulnerability factors.

A Blended Cognitive–Behavioral Intervention for the Treatment of Postpartum Depression: A Case Study

Postpartum depression is a highly prevalent mental health problem with harmful consequences for women, babies, and mother–infant relationships. Cognitive–behavioral therapy (CBT) is among the most effective treatment options for postpartum depression. However, a large number of postpartum women do not seek professional help, suggesting the need for new treatment delivery formats. The present article describes the application of Be a Mom Coping with Depression, a blended CBT treatment for postpartum depression, for a 31-year-old postpartum woman. The intervention was provided over a period of 13 weeks, integrating seven biweekly sessions with a psychologist and six sessions within an online program, and it is described in detail. A summary of the patient’s progress and the results obtained throughout treatment is reported. At the end of the intervention, a significant decrease in depressive and anxiety symptoms was observed, as well as increased perceived maternal self-efficacy, higher psychological flexibility, and higher self-compassion. This case study provides encouraging data for the preliminary evidence of the acceptability, feasibility, and efficacy of the Be a Mom Coping with Depression intervention in the reduction of depressive symptoms during the postpartum period. Advantages of this treatment format and implications for clinical practice and future research are discussed.

Physical and Emotional Intimate Partner Violence and Women's Health in the First Year After Childbirth: An Australian Pregnancy Cohort Study

Intimate partner violence (IPV) can comprise physical, sexual, and emotional abuse, and is a widespread public health concern. Despite increasing recognition that women experience different types of IPV, the majority of research has focused on physical IPV. The present study aims to examine associations between different types of IPV (physical, emotional, physical, and emotional) and women's mental, physical, and sexual health by analyzing longitudinal data from a prospective pregnancy cohort of 1,507 first-time mothers in Melbourne, Australia. Questionnaires included validated measures of physical and mental health (Short Form Health Survey, Edinburgh Postnatal Depression Scale) and IPV (Composite Abuse Scale). Emotional IPV alone was the most commonly reported type of IPV (n = 128, 9.5%), followed by both physical and emotional IPV (n = 76, 5.7%), and then physical IPV alone (n = 30, 2.2%). Women reporting emotional IPV or physical and emotional IPV had increased odds of poor health compared with women reporting no IPV. Experience of physical and emotional IPV was most strongly associated with mental health issues, including depressive symptoms (adjusted odds ratio [OR] 4.6, 95% confidence interval [CI] = [2.9, 7.1]) and self-reported anxiety (adjusted OR 2.9, 95% CI = [1.9, 4.4]). Experience of emotional IPV alone was associated with poor mental health as well as physical factors, including poor general physical health (adjusted OR 1.9, 95% CI = [1.2, 3.1]), and pain during sex (adjusted OR 1.8, 95% CI = [1.2, 2.7]). Increased odds of poor body image were also observed for women reporting emotional IPV alone and physical and emotional IPV. These findings highlight the need for greater awareness of the diversity in women's experiences of IPV among health care providers. This includes understanding the prevalence of emotional IPV among new mothers, and the range of health problems that are more common for women experiencing IPV.

Influence of parity and infant age on maternal self-efficacy, social support, postpartum anxiety, and postpartum depression in the first six months in the Maritime Provinces, Canada

BACKGROUND

After giving birth, women experience significant changes related to maternal self-efficacy and social support and are at risk of experiencing postpartum anxiety and depression.

PROBLEM

No studies have focused on the relationship between parity and infant age and their impact on psychosocial outcomes, particularly in a Canadian context.

AIM

To explore the relationship between parity and infant age on perceived maternal self-efficacy, social support, postpartum anxiety, and postpartum depression.

METHODS

Women from three Canadian provinces within the first 6 months postpartum completed standardized online questionnaires. Multivariate analysis of covariance was used to examine the primary aim.

FINDINGS

A total of 561 women (56.5% primiparous, 55.1% infant 0-3 months) participated. There were significant main effects for both parity (P < .001) and age of infant (P < .001), but no significant interaction (P = .463). Primiparous women had lower maternal self-efficacy (P = .004) and higher postpartum anxiety (P = .000) than multiparous women. Women with younger infants had more perceived social support (P = .002). Women with older infants had higher levels of postpartum anxiety (P = .003) and depression (P = .000).

DISCUSSION

The transition that women experience, independent of parity, within the first six months is dynamic with women of older infants experiencing more postpartum mental health concerns and less perceived social support. Our findings emphasize that postnatal support should extend beyond the typical six-week follow-up period.

CONCLUSIONS

Additional studies are warranted to determine ways to provide ongoing support throughout the first six months and beyond to improve maternal well-being and address postpartum needs.

The maternal health study: Study design update for a prospective cohort of first-time mothers and their firstborn children from birth to age ten

BACKGROUND

Maternal health is critical to the health and well-being of children and families, but is rarely the primary focus of pregnancy and birth cohort studies. Globally, poor maternal health and the exposure of women and children to family violence contribute to the perpetuation and persistence of intergenerational health inequalities.

OBJECTIVES

The Maternal Health Study was designed to investigate the contribution of social and obstetric risk factors to common maternal physical and psychological morbidities. Over time, our focus has expanded to include mother-child pairs and investigation of intergenerational trauma and family violence.

POPULATION

A total of 1507 first-time mothers were recruited in early pregnancy from six public hospitals in Melbourne, Australia, in 2003-2005.

METHODS

Women completed questionnaires or telephone interviews in early pregnancy (≤24 weeks); at 32 weeks' gestation; at three, six, nine, 12 and 18 months postpartum; and at four and ten years. At ten years, women and children were invited to participate in face-to-face interviews, which included direct assessment of children's cognitive and language development. A wide range of obstetric, social and contextual factors have been measured, including exposure to intimate partner violence (IPV) (1-year, 4-year and 10-year follow-up).

RESULTS

1507 eligible women were recruited at a mean gestation of 15 weeks. At one year, four years and ten years postpartum, 90.0%, 73.1% and 63.2% of the original cohort took part in follow-up. One in three women in the study (34.5%) reported exposure to IPV in the first ten years of motherhood: 19% in the first 12 months postpartum, 20% in the year prior to four-year follow-up and 18.3% in the year prior to ten-year follow-up.

CONCLUSION

The study affords a unique opportunity to examine patterns of maternal and child health and health service use associated with exposure to IPV.

Do Maternal Stress and Depressive Symptoms in Perinatal Period Predict the Lactation Mastitis Occurrence? A Retrospective Longitudinal Study in Greek Women

Background: The aim of this study is to investigate whether symptoms of anxiety and depression disorders in women during the perinatal period predict the occurrence of lactation mastitis. Methods: This is a retrospective longitudinal study of 622 Greek women who were monitored from pregnancy until the first year postpartum (during the period January 2015–May 2018). The Edinburgh Postnatal Depression Scale (EPDS) and the Perinatal Anxiety Screening Scale (PASS) were administered at four time points: (a) 24th–28th gestation week, (b) 34th–38th gestation week, (c) 6 weeks postpartum, and (d) 12 months postpartum. Multivariate binary logistic regression analyses were performed. Results: Results showed that (a) increased EPDS (p < 0.02) and PASS (p < 0.05) scores during the last period before birth, (b) increased EPDS score at 6 weeks postpartum (p < 0.02), (c) PMS symptoms (p < 0.03), (d) traumatic life events during the last year (p < 0.03), and (e) the existence of a history of psychotherapy (before pregnancy) (p = 0.050) appear to be the psycho-emotional factors that can predict the possible occurrence of lactation mastitis in a breastfeeding mother. Conclusions: The association between women’s poor mental health and the occurrence of a physical health problem, such as lactation mastitis, is recognized. This study highlights the important role of early and timely detection of perinatal mental health disorders.

Effect estimate of time-varying social support and trust on the physical and mental health of mothers at 2.5 years postpartum: The Japan Environment and Children's Study (JECS)

BACKGROUND

Many epidemiological studies have reported the association between various social factors and health status in mothers during and after pregnancy. However, little is known about their joint and longitudinal impact. We therefore examined the association of lack of social support and trust during pregnancy and at 2.5 years postpartum with health status in mothers.

METHODS

To adequately address time-varying exposure, marginal structural models were fitted to a pseudopopulation constructed by inverse probability weighting. The model included records of 90,071 mothers participating in the Japan Environment and Children's Study. Social support and trust were measured using a 9-item questionnaire (Q1-9). Mental and physical health were measured using Mental and Physical Component Summary scores from the 8-item Short-Form Health Survey.

RESULTS

For the Mental Component Summary, the magnitude of the effect estimate was largest when participants lacked close friends/neighbors (Q4) at only 2.5 years postpartum (= -6.23), followed by a lack in emotional support (Q2) at the same time point (= -4.94). For the Physical Component Summary, effect estimates were negligible. The magnitude of the effect estimates of lack of social support and trust tended to be larger when there was a lack at only 2.5 years postpartum than at both time points.

CONCLUSIONS

These findings suggest that, after childbirth, a loss in social support, particularly in a concrete or instrumental aspect, carries high risk, especially for mental health. Our results highlight the importance of supporting mothers for more than a few years after pregnancy.

Prevalence and predictors of postpartum depression in Upper Egypt: A multicenter primary health care study

BACKGROUND

Postpartum depression (PPD) is highly prevalent with a major impact on the mother and child health. We aimed to determine the prevalence of PPD in primary health care centres which provide vaccinations services to infants in Assiut city and to evaluate the possible risk factors associated with PPD.

METHODS

In this multicentre study, 257 mothers attended three primary health care centres for immunization of their babies were recruited from January 2019 to January 2020. All participants were evaluated for socio-demographic features, Family affluence scale (FAS), Edinburgh Postnatal Depression Scale (EPDS) and associated risk factors.

RESULTS

The mean age of the participants was 27.98 ± 4.7. About half of the mothers and their husbands had low education level. Most of the families (89%) have low socioeconomic scale (SES). About (33.5%) women were found to have possible PPD. In the logistic regression analysis, SES, history of depression, history of PPD, history of stressful conditions, familial support, unwanted pregnancy, and male preference were significant statistical in PPD (p < 0.05).

LIMITATIONS

We did not investigate the medical and psychological problems during antenatal care. Also, we did not assess relation of the type of delivery and medical problems during delivery on the postnatal care.

CONCLUSIONS

PPD was prevalent in 33.5% The possible risk factors of PPD were low SES, history of depression, history of PPD, history of stressful conditions, familial support, unwanted pregnancy, and male preference.

Effectiveness of a brief psychoeducational intervention on postnatal depression in the slums, Nairobi: a longitudinal study

Research has shown that postnatal depression (PND) is higher in low- and middle-income countries as compared to higher-income countries. Despite this, little is known about practical interventions in these poorly resourced countries. This research investigated the effectiveness of a brief, prophylactic and therapeutic psychoeducational intervention in a low-resourced community in Nairobi. Two closely similar Maternal and Child Health (MCH) clinics in urban slums in Nairobi were identified and randomly selected. A total of 567 mothers formed the study population. The experimental group (284) mothers received the intervention, which included psychoeducation on PND, coping skills, healthy way of mother/child interaction and infant stimulation in addition to routine treatment, while the control group (283) mothers received treatment as usual. Data was collected using a social-demographic questionnaire and the English version of Becks Depression Inventory (BDI) at baseline. At 6 months, we reassessed both groups using BDI only. Within group comparison, the percentage reduction of depression was 35.6% among the experimental as compared to 2.3% in the control group. Between group comparison, the mean BDI depression score was significantly low in the experimental arm compared to the control arm at endline (p = 0.025). When all variables were adjusted, using a generalized linear model, BDI depression score reduction among the participants was significantly associated with the intervention (p = 0.040). A brief, psychoeducational intervention that targets the mother and her infant may reduce PND even in poorly resourced environments. Therefore, it can be integrated into existing MCH services.

Prevalence of Postpartum Depression and Associated Risk Factors Among Women in Jeddah, Western Saudi Arabia

Background

Postpartum depression (PPD) is a significant psychological disorder that can affect women during or after pregnancy. Its risk increases throughout the first 90 days and may last up to almost two years, which can create an overall burden on society. Although the etiology is unknown yet, there are risk factors that contribute to developing PPD. This study aims to assess the prevalence of PPD and the risk factors among women in Jeddah, western Saudi Arabia in 2019.

Methods

A cross-sectional study was conducted in infant vaccination clinics of the primary healthcare centers (PHC) of the Ministry of Health (MOH) and Ministry of National Guard (MNGHA) Jeddah, Saudi Arabia. Data were collected through a self-administered questionnaire with Edinburgh Postnatal Depression Scale (EPDS) from mothers up to four months postpartum.

Results

Of the 172 postpartum women, the study estimated the prevalence of postpartum depression to be 20.9%. The significant risk factors predicted by multivariate regression analysis were history of previous depression (odds ratio {OR}=4.7; 95% confidence interval {CI} 1.9 to 11.5), difficult life event interval (OR=3.5; 95% CI 1.1 to 10.7), and attitude toward pregnancy (OR=2.1; 95% CI 0.9 to 4.5).

Conclusion

A fairly high prevalence of postpartum depression was revealed among the females in Jeddah. Therefore, we recommend screening of mothers after delivery to help early intervention and management along with psychosocial support.

The Effects of Taping Combined with Wrist Stabilization Exercise on Pain, Disability, and Quality of Life in Postpartum Women with Wrist Pain: A Randomized Controlled Pilot Study

The purpose of this study was to evaluate the effects of wrist stabilization exercise combined with taping on wrist pain, disability, and quality of life in postpartum women with wrist pain. Forty-five patients with wrist pain were recruited and randomly divided into three groups: wrist stabilization exercise + taping therapy (WSE + TT) group (n = 15), wrist stabilization exercise (WSE) group (n = 15), and control group (n = 15). The WSE + TT and WSE groups performed wrist stabilization exercises for 40 min (once a day, five times a week for eight weeks), and the control group performed passive range of motion (P-ROM) exercise for the same amount of time. Additionally, the WSE + TT group attached taping to the wrist and forearm during the training period. The visual analogue scale (VAS) was used to assess pain level of the wrist. The Disabilities of the Arm, Shoulder and Hand (DASH) and the Short Form-36 (SF-36) were used to evaluate the degree of wrist disability and quality of life, respectively. The WSE + TT group showed a significant decrease in wrist pain and functional disability compared to two groups (p < 0.05). Significant improvement in the SF-36 score was observed in the WSE + TT and WSE groups compared to that in the control group (p < 0.05). However, there was no significant difference between the WSE + TT and WSE groups in the SF-36. Our findings indicate that wrist stabilization exercise combined with taping is beneficial and effective in managing wrist pain and disability in postpartum women with wrist pain.

Does Urinary Incontinence and Mode of Delivery Affect Postpartum Depression? A Nationwide Population-Based Cohort Study in Korea

We investigated the association between urinary incontinence and postpartum depression. Data were extracted from the Korean National Health Insurance Service-National Sample Cohort and included women who delivered between 2004 and 2013. Postpartum depression was determined using diagnostic codes during the six-month postpartum period. Urinary incontinence was identified as having a prescription of incontinence drugs or a diagnosis. Cox proportional hazard models were used to calculate adjusted hazard ratios. Of the 83,066 women, 5393 (6.49%) had urinary incontinence and 691 (0.83%) had postpartum depression. Postpartum depression was higher among women with urinary incontinence, aged 15–19 years, ≥40 years old, the lowest income level, and who underwent cesarean section delivery. In the combined analysis, women with urinary incontinence and cesarean section had an approximately three times higher risk of postpartum depression compared with those without urinary incontinence and with spontaneous delivery. Women without urinary incontinence and cesarean section, and those with urinary incontinence and spontaneous delivery were at higher risk of postpartum depression compared with the reference group. Urinary incontinence and cesarean section delivery were significantly associated with postpartum depression during the first six months after childbirth. Therefore, further research should be conducted to evaluate whether urinary incontinence contributes to postpartum depression.

Psychological distress and mother-child relationship: influence of life context on a population sample (BRISA) through the use of directed acyclic graphs (DAG)

This study aimed to investigate the association between maternal psychological distress and impairment in mother-child relationship in a sample from a Northeast capital city in Brazil with a low Human Development Index, using directed acyclic graphs (DAG). A total of 3,215 women were evaluated for the presence of psychological distress through the Self Reporting Questionnaire instrument and for the mother-child relationship by the first factor of Postpartum Bonding Questionnaire, considered the most appropriate in the literature. Demographic and socioeconomic variables were used to construct a theoretical model and, after this, multivariate logistic regression was performed using variables suggested by Directed Acyclic Graphs (DAG). Psychological distress was present in 22.7% of the women and 12.6% of them presented impaired mother-child relationships. After adjustment, the variable 'maternal mental distress' remained associated with impaired mother-child relationship (RR=3.03), and among the explanatory variables only 'primary school level' (RR=1.48) was associated as a risk factor to this outcome. The results indicated that, in this population, women with psychological distress and lower schooling are more likely to present impaired mother-child relationships.

Maternal mental health and coping during the COVID-19 lockdown in the UK: Data from the COVID-19 New Mum Study

OBJECTIVE

To assess how mothers are feeling and coping during lockdown, and to identify the potential pathways that can assist them.

METHODS

A descriptive analysis of maternal mental health, coping, support, activities, lockdown consequences was conducted. Women living in the UK with an infant aged ≤12 months completed an online survey. Linear regression was used to identify predictors of maternal mental health and coping.

RESULTS

A majority of the 1329 participants reported feeling down (56%), lonely (59%), irritable (62%), and worried (71%) to some extent since lockdown began, but 70% felt able to cope. Support with her own health (95% confidence interval [CI] 0.004-0.235), contacting infant support groups (95% CI -0.003 to 0.252), and higher gestational age of the infant (95% CI 0.000-0.063) predicted better mental health. Travelling for work (95% CI -0.680 to -0.121), the impact of lockdown on the ability to afford food (95% CI -1.202 to -0.177), and having an income <£30 000 (95% CI -0.475 to -0.042) predicted poorer mental health. Support with her own health and more equal division of household chores were associated with better coping.

CONCLUSION

There is a need to assess maternal mental health and identify prevention strategies for mothers during lockdown.

Bidirectional relationship between physical health symptoms and depressive symptoms in the pre- and postpartum period

OBJECTIVE

To test the bidirectional relationships between physical health symptoms (PHS) and depressive symptoms (DS) as well as between the intensity of 'any pain' and DS in the pre- and postpartum period METHOD: Women (N = 615) completed the Edinburgh Postnatal Depression Scale, the Patients Health Questionnaire-15, and numerical pain rating scales when they were between 32 and 37 weeks of gestation, and subsequently one, three, and six months postpartum. We conducted two random intercept cross-lagged panel models (RI-CLPM) RESULTS: Both models presented excellent fits. The relationship between PHS and DS was bidirectional across all the data waves (χ²(9) = 6.610, p = .678, CFI = 1, TLI = 1, RMSEA = 0). The magnitude of the standardized cross-lagged regression coefficient was relatively similar from DS to PHS (raging between 0.081 and 0.171); and from PHS to DS (raging between 0.121 and 0.138). The relationship between 'any pain' intensity and DS was also bidirectional, but only during the postnatal period (χ²(9) =11.765, p = .227, CFI = 0.99, TLI = 0.98, RMSEA = 0.022). The magnitude of the standardized cross-lagged regression coefficient was higher from DS to 'any pain' intensity (raging between 0.214 and 0.216); than from 'any pain' intensity to DS (raging between 0.092 and 0.097).

CONCLUSIONS

Concurrently intervening over physical and mental health symptoms could promote women's perinatal health.

A Blended Cognitive-Behavioral Intervention for the Treatment of Postpartum Depression: Study Protocol for a Randomized Controlled Trial

Despite the existence of effective treatment for postpartum depression, few women seek professional help, indicating the need for a new and innovative format of treatment that can overcome help-seeking barriers. This article presents the study protocol for a blended cognitive–behavioral intervention for the treatment of postpartum depression, by integrating face-to-face sessions with a web-based program (Be a Mom) into one treatment protocol. This study will be a two-arm, noninferiority randomized controlled trial comparing blended intervention to usual treatment for postpartum depression provided in healthcare centers. Portuguese postpartum adult women diagnosed with postpartum depression (according to the DSM-5 diagnostic criteria for major depressive disorder) will be recruited during routine care appointments in local healthcare centers and will be eligible to participate. Measures will be completed at baseline, postintervention, and at three- and six-month follow-ups. The primary outcome will be depressive symptoms. Secondary outcomes will include anxiety symptoms, fatigue, quality of life, marital satisfaction, maternal self-efficacy, and mother–child bonding. Cost-effectiveness analysis and mediator and moderator analysis will be conducted. This study will provide insight into the efficacy and cost-effectiveness of a blended psychological intervention in the Portuguese context and increase the empirically validated treatment options for postpartum depression.

Screening Beyond Postpartum Depression: Occluded Anxiety Component in the EPDS (EPDS-3A) in French Mothers

INTRODUCTION

According to many studies, anxiety in the perinatal period is widespread and has many detrimental effects. Thus, screening measures should not be limited to assessing depression symptoms. The widely used Edinburgh Postnatal Depression Scale (EPDS) might assess depression but also anxiety symptoms. This study explores whether an anxiety dimension (EPDS-3A) was found and valid in French women during pregnancy and the postpartum period.

METHODS

French women were followed-up at late pregnancy and 2 and 4 months postpartum (N = 144, 138 and 129). They completed the EPDS and the Hospital Anxiety and Depression Scale (HADS-A). Exploratory factor analyses were performed. Then to test its validity, the EPDS-3A was correlated with anxiety (HADS-A) and depression (EPDS-D) scores. Finally, prevalence estimates were computed according to recommended cut off.

RESULTS

The anxiety dimension assessed through the EPDS-3A was observed during the postpartum period but not during pregnancy. A two-factor structure (depression and anxiety) increases the variance explained at 2 and 4 months postpartum (respectively 6 and 12%). The EPDS-3A shows good internal consistency (≥ .70) and was more strongly associated with anxiety scores (HADS-A) (.48-.57) than with depression scores (EPDS-D) (.30-.39). Nearly 28% of mothers had scores that exceeded the EPDS-3A cut off (≥ 4) but not the full EPDS cut off (≥ 13 or more).

DISCUSSION

The EPDS contains an anxiety component (EPDS-3A) that can be found in French women during the postnatal period but not during pregnancy. It shows signs of internal consistency and validity. The EPDS-3A could be considered when screening for postpartum anxiety.

Be a Mom, a Web-Based Intervention to Prevent Postpartum Depression: Results From a Pilot Randomized Controlled Trial

Be a Mom is a self-guided web-based intervention, grounded in cognitive behavioral therapy, delivered to postpartum women to prevent persistent postpartum depression [PPD] symptoms. We aimed to evaluate Be a Mom in terms of its preliminary efficacy, feasibility, and acceptability. A pilot randomized, two-arm controlled trial was conducted. Eligible women (presenting PPD risk-factors and/or early-onset PPD symptoms) were enrolled in the study and were randomly assigned to the intervention (Be a Mom) or to the waiting-list control group. Participants in both groups completed baseline (T1) and postintervention (T2) assessments. The 194 women presenting risk factors/early-onset PPD symptoms were allocated to the intervention (n = 98) or to the control (n = 96) group. A significant Time × Group interaction effect was found for both depressive and anxiety symptoms, with women in the intervention group presenting a larger decrease in symptoms from T1 to T2 (p < .05). Less than half of the women (41.8%) completed Be a Mom. Most women (71.4%) would use Be a Mom again if needed. Results provide preliminary evidence of the Be a Mom's efficacy, acceptability and feasibility, although further research is needed to establish Be a Mom as a selective/indicative preventive intervention for persistent PPD.

Be a Mom's Efficacy in Enhancing Positive Mental Health among Postpartum Women Presenting Low Risk for Postpartum Depression: Results from a Pilot Randomized Trial

In this study, we conducted a preliminary investigation of the efficacy of Be a Mom, a web-based self-guided intervention, in enhancing positive mental health among postpartum women at low risk for postpartum depression. Additionally, we examined Be a Mom’s efficacy regarding secondary outcomes as well as its acceptability and adherence. A total of 367 participants were randomly assigned to the Be a Mom group (n = 191) or to the waiting-list control group (n = 176) and completed baseline (T1) and postintervention (T2) assessments. The intervention group reported significant increases in positive mental health between T1 and T2 compared to the control group. Additionally, group effects were found for depressive and anxiety symptoms. A significantly higher proportion of participants in the Be a Mom group had an improvement trajectory (from not flourishing at T1 to flourishing at T2). A total of 62 (32.5%) women completed Be a Mom, and most would use it again if needed (n = 82/113; 72.6%). This study provides preliminary evidence of Be a Mom’s efficacy in increasing positive mental health among low-risk postpartum women. Our findings support mental health promotion strategies in the postpartum period and highlight the important role of web-based CBT interventions.

Ropivacaine 75 mg versus placebo in perineal infiltration for analgesic efficacy at mid- and long-term for episiotomy repair in postpartum women - the ROPISIO study: a two-center, randomized, double-blind, placebo-controlled trials

Background

Perineal pain due to episiotomy is commonly reported and can be severe enough to disturb the mother–infant dyad during the postpartum period. Its incidence at day 7 postpartum varies from 63% to 74%. Recent studies have investigated the analgesic efficacy of perineal infiltration of ropivacaine after episiotomy but have only focused on the immediate postpartum period (at 24 and 48 h after birth). Large, adequately powered, multicenter, randomized controlled trials are required to evaluate the impact of ropivacaine infiltration on perineal pain and mid- and long-term quality of life before the widespread use of ropivacaine to prevent perineal pain after episiotomy can be recommended.

Methods/design

The ROPISIO study is a two-center, randomized, double-blind, placebo-controlled trial being conducted in La Roche sur Yon and Nantes, France. It will involve 272 women with vaginal singleton delivery and mediolateral episiotomy at term (≥ 37 weeks). Perineal infiltration (ropivacaine 75 mg or placebo) will be administrated just after vaginal birth and before episiotomy repair. The primary outcome will be the analgesic efficacy at day 7 postpartum (midterm), defined by the Numeric Pain Rating Scale (NPRS) strictly superior to 3/10 on the perineal repair area. Secondary outcomes will be the analgesic efficacy (NPRS) and the impact of pain on daily behavior, on the quality of life (36-item Short Form Health Survey), on the occurrence of symptoms of postpartum depression (Edinburgh Postnatal Depression Scale), and on sexual health (Female Sexual Function Index) at 3 and 6 months (long-term) using validated online questionnaires. This study will have 90% power to show approximately 30% relative risk reduction in the incidence of perineal pain at day 7, from 70.0% to 50.0%.

Discussion

Ropivacaine is a promising candidate drug, inexpensive, and easy to administer, and it would be suitable to include in the routine management of deliveries in labor ward. This study will investigate if perineal ropivacaine infiltration just after birth can reduce mid- and long-term postpartum pain and increase quality of life in women with mediolateral episiotomy.

Trial registration

ClinicalTrials.gov, NCT03084549. Registered on 14 April 2017.

Longitudinal Relationship Study of Depression and Self-Esteem in Postnatal Korean Women Using Autoregressive Cross-Lagged Modeling

Individuals with low self-esteem are vulnerable to depression. Depressed individuals process information related to themselves in a distorted way, thereby negatively affecting their self-esteem. The purpose of this study was to examine the relationship between depression and self-esteem in postnatal Korean women using longitudinal data and an autoregressive cross-lagged analysis. This study was conducted in postpartum women who had consistently participated in the Panel Study on Korean Children (PSKC) from Wave 1 through to Wave 8. The study results showed that depression and self-esteem in postnatal women had a significant positive correlation over time. Moreover, the longitudinal relationship between depression and self-esteem in postnatal women was affected by weight gain during pregnancy. This study overcomes the limitations of cross-sectional studies by using longitudinal data on the correlations between depression and self-esteem in postnatal women; the study findings may be used in developing weight control programs for pregnant and postnatal women.

Prevalence of Positive Mental Health and Associated Factors Among Postpartum Women in Canada: Findings from a National Cross-Sectional Survey

Objectives

The objectives of this study were to compare the prevalence of three positive mental health (PMH) outcomes (self-rated mental health, life satisfaction, sense of community belonging) in postpartum women to the general population, and to examine the relationship between protective factors and the three PMH outcomes among postpartum women.

Methods

The national cross-sectional Survey on Maternal Health (n = 6558) was analyzed. Analyses were weighted and 95% confidence intervals were calculated. Three adjusted logistic regression models were generated. To compare this sample to the general population of women, estimates from the Canadian Community Health Survey—Annual Component (2018) were used.

Results

Compared to the general population of women, a larger proportion of postpartum women reported a strong sense of community belonging. The odds of postpartum women with high self-rated physical health having high self-rated mental health were approximately seven times greater (aOR 6.9, 95% confidence interval [CI] 5.9, 8.1) than postpartum women with lower self-rated physical health. The absence of symptoms of postpartum depression (PPD) or generalized anxiety disorder (GAD) and high self-rated physical health were significantly associated with all three PMH outcomes. Frequent availability of maternal support was associated with greater odds of high life satisfaction (aOR 1.6, 95% CI 1.4, 1.9) and sense of community belonging (aOR 1.4, 95% CI 1.2, 1.6).

Conclusions

Our study demonstrated that availability of maternal support, self-rated physical health and absence of symptoms of PPD or GAD were associated with PMH among postpartum women. As physical health had the strongest association with mental health, we encourage further examination of this relationship.

Electronic supplementary material

The online version of this article (10.1007/s10995-020-02920-8) contains supplementary material, which is available to authorized users.

Association between Stress Urinary Incontinence and Depressive Symptoms after Birth: the Czech ELSPAC Study

The study objectives were to (1) identify risk factors related to stress urinary incontinence (SUI) and postnatal depression (PD) after birth, and (2) investigate both possible directions of association between SUI and PD in population-based sample of Czech mothers. 3,701 nulliparous and multiparous women completed the self-reported questionnaires at 6 weeks and 6 months after birth and were included into the analyses of this prospective cohort study. Unadjusted and adjusted logistic regressions examined relationship between SUI a PD accounting for range of other risk factors. During the first 6 months after birth, 650 mothers (17.6%) developed SUI and 641 (17.3%) displayed signs of PD. The mode of delivery, parity and higher BMI were associated with SUI. The rate of PD symptoms was higher in mothers with positive history of prenatal depression, and in divorced or widowed mothers. Both conditions were associated with worse self-reported health, back pain and stop-smoker status. Initially, SUI at 6 weeks was slightly, but significantly associated with onset of PD at 6 months (OR 1.51, 95% CI 1.02–2.23) while PD at 6 weeks was not significantly related to new cases of SUI at 6 months (OR 1.48, 95% CI 0.91–2.39). After full adjustment these OR reduced to 1.41 and 1.38 (both non-significant), respectively. SUI and PD are common conditions in women postpartum that share some risk factors. Our study suggests that both directions of their relationship are possible although a larger study is needed to confirm our findings.

Preventing Postpartum Depression With Mindful Self-Compassion Intervention: A Randomized Control Study

Mindfulness and self-compassion are reported to have a preventive effects on depression and anxiety disorders. In the present study, we aimed to assess the effect of mindful self-compassion intervention on preventing postpartum depression in a group of symptomatic pregnant women. Participants were screened and assigned to the intervention and control groups randomly. A 6-week Internet-based Mindful Self-Compassion Program was used to train the participants. Multiple scales were used to assess depressive and anxiety symptoms, mindfulness, self-compassion, and mother and infant well-being. All assessments were performed at three time points: baseline, 3 months, and 1 year postpartum. Compared with the control group, the intervention group showed significant improvement in depressive and anxiety behaviors. In addition, the intervention group became more mindful and self-compassionate at 3 months and 1 year postpartum. More importantly, both mothers and infants experienced substantial improvement in well-being. Our findings indicate that mindful self-compassion intervention is effective in preventing postpartum depression and promoting mother and infant well-being.

Peer supporters' experiences on an Australian perinatal mental health helpline

Perinatal mental health is an important public health issue, and peer support is a potentially important strategy for emotional well-being in the perinatal period. PANDA Perinatal Anxiety & Depression Australia provides support to individuals impacted by perinatal mental health issues via the National Perinatal Anxiety & Depression Helpline. Callers receive peer support from volunteers and counselling from paid professional staff. The views and experiences of PANDA peer support volunteers have not previously been studied. We conducted two focus groups and an online survey to explore the experiences of women providing volunteer peer support on the Helpline. Data collection took place in October and November 2013. Two social theories were used in framing and addressing the study aims and in interpreting our findings: the Empathy-Altruism Hypothesis, and the Helper Therapy Principle. All PANDA volunteers were invited to participate (n = 40). Eight volunteers attended a focus group, and 11 survey responses were received. Descriptive statistics were used to analyse quantitative data. All survey respondents 'strongly agreed' that they felt positive about being part of PANDA. Thematic analysis of data from focus groups and open-ended survey responses identified the following themes: motivated to help others, supported to support callers, helping to make a difference and emotional impacts for volunteers. Respondents described a strong desire to support others experiencing emotional distress as a motivator to volunteer. Although perinatal peer support services are designed to benefit those who receive support, this study suggests volunteers may also experience personal benefits from the role.

Face-to-face health professional contact for postpartum women: A systematic review

The postpartum period is a time when physical, psychological and social changes occur. Health professional contact in the first month following birth may contribute to a smoother transition, help prevent and manage infant and maternal complications and reduce health systems' expenditure. The aim of this systematic review was to assess the effect of face-to-face health professional contact with postpartum women within the first four weeks following hospital discharge on maternal and infant health outcomes. Fifteen controlled trial reports that included 8332 women were retrieved after searching databases and reference lists of relevant trials and reviews. Although the evidence was of moderate or low quality and the effect size was small, this review suggests that at least one health professional contact within the first 4 weeks postpartum has the potential to reduce the number of women who stop breastfeeding within the first 4-6 weeks postpartum (Risk Ratio 0.86 (95% Confidence Interval 0.75-0.99)) and the number of women who cease exclusive breastfeeding by 4-6 weeks (Risk Ratio 0.84 (95% Confidence Interval 0.71-0.99)) and 6 months (Risk Ratio 0.88 (95% Confidence Interval 0.81-0.96). There was no evidence that one form of health professional contact was superior to any other. There was insufficient evidence to show that health professional contact in the first month postpartum, at a routine or universal level, had an impact on other aspects of maternal and infant health, including non-urgent or urgent use of health services.

Measuring physical and mental health during pregnancy and postpartum in an Australian childbearing population - validation of the PROMIS Global Short Form

Background

Health related quality of life is a critical concept during the perinatal period but remains under-researched. The International Consortium for Health Outcomes Measurement have included the Patient Reported Outcomes Measurement Information System (PROMIS®) Global Short Form (GSF) in their core outcome set for pregnancy and childbirth to measure health related quality of life. The PROMIS GSF has not been fully evaluated as a valid and reliable instrument in this population. This study assessed the psychometric properties of the PROMIS GSF during pregnancy and postpartum period.

Methods

PROMIS GSF was administered to a sample of 309 pregnant women at four time-points during pregnancy (≤ 27 and 36-weeks) and postpartum (6- and 26-weeks). The structural validity, internal consistency reliability, construct validity, and responsiveness of the PROMIS GSF were evaluated. The internal structure of the PROMIS GSF was explored using Rasch Measurement Theory. Response format, item fit, differential item functioning (item bias), dimensionality of the scale and its targeting were assessed.

Results

Two revised subscales (Mental Health: four items; and Physical Health: five items) showed good fit to the Rasch model. The revised mental health subscale demonstrated good internal consistency reliability during pregnancy and postpartum period (α = .88 and .87, respectively). The internal consistency reliability of the physical health subscale was adequate (α = .76 and .75, respectively). The revised mental health subscale was sensitive to group differences according to a history of mental health disorder, income, smoking status, drug use, stress levels and planned versus unplanned pregnancy. Differences in scores on the revised physical subscale were detected for groups based on obesity, income, drug use, smoking status, stress, and history of mental health disorders. Scores on both subscales recorded significant changes across the four time-points, spanning pregnancy and postpartum period.

Conclusions

The revised version of the PROMIS GSF was better able to measure mental and physical health during pregnancy and postpartum period compared to the original version. Findings support the clinical and research application of the PROMIS GSF within the International Consortium for Health Outcomes Measurement Standard Set of Outcome Measures for Pregnancy and Childbirth. Ongoing psychometric analysis of the PROMIS GSF is recommended in other maternity populations.

Infection and wound breakdown in spontaneous second-degree perineal tears: An exploratory mixed methods study

BACKGROUND

Perineal trauma affects large numbers of women who have a vaginal birth. This study explores the incidence, etiology and women's experiences of wound infection/breakdown associated with spontaneous second degree tears.

METHODS

This was an exploratory mixed methods study set in an urban tertiary National Health Service hospital in 2014-2015. The study included a prospective observational study of second-degree tears using electronic patient records. Infection was defined using criteria adapted from Public Health England's Surgical Site Infection Surveillance Service. We also did a case-control study of maternity records to explore factors associated with perineal infection/wound breakdown, and semi-structured interviews with a purposeful sample of women who experienced wound infection/breakdown.

RESULTS

Of 2892 vaginal births during the study period, 76.8% sustained perineal trauma, with second-degree tears most commonly recorded (n = 828/28.6%). Sixteen (1.9%) had a documented infection/wound breakdown which were associated with "compromised wound status" (increased severity of wound/poor suturing; P = 0.033) Women complained of a lack of information about their perineum and poor postnatal surveillance by midwives and physicians. Diagnosis and treatment were often delayed by clinicians' reliance on external signs of wound infection. Although the sample size was small, there were no differences in rates of infection between sutured and unsutured second-degree tears.

CONCLUSIONS

Although second-degree tears were common after vaginal birth, wound infection/breakdown was relatively uncommon. Women who report feeling unwell or develop pyrexia postnatally should be assessed urgently. A prospective longitudinal study exploring the long-term sequelae of second-degree tears is needed.

Postpartum emergency department use among women with intellectual and developmental disabilities: a retrospective cohort study

Background

An emerging body of evidence underscores the often-intensive perinatal healthcare needs of women with intellectual and developmental disabilities (IDD). However, population-based research examining postpartum experiences of US women with IDD is sparse. We examined emergency department (ED) use in the postpartum period among Massachusetts mothers with IDD.

Methods

We analysed 2002–2010 Massachusetts Pregnancy to Early Life Longitudinal data to compare any and ≥2 ED visits between mothers with and without IDD: within 1–42 days post partum, 1–90 days post partum and 1–365 days post partum. We also determined whether or not such ED use was non-urgent or primary-care sensitive.

Results

We identified 776 births in women with IDD and 595 688 births in women without IDD. Across all three postpartum periods, women with IDD were vastly more likely to have any postpartum ED use, to have ≥2 ED visits and to have ED visits for mental health reasons. These findings persisted after controlling for numerous sociodemographic and clinical characteristics. Women with IDD were less likely to have non-urgent ED visits during the three postpartum periods and they were less likely to have primary-care sensitive ED visits during the postpartum period.

Conclusion

These findings contribute to the emerging research on perinatal health and healthcare use among women with IDD. Further research examining potential mechanisms behind the observed ED visit use is warranted. High ED use for mental health reasons among women with IDD suggests that their mental health needs are not being adequately met.

Be a Mom, a Web-Based Intervention to Prevent Postpartum Depression: The Enhancement of Self-Regulatory Skills and Its Association With Postpartum Depressive Symptoms

Aim: Be a Mom is a self-guided, web-based intervention to prevent persistent postpartum depression symptoms [PPD], targeting both at-risk postpartum women and/or women presenting early-onset postpartum depressive symptoms (selective/indicated preventive intervention). Be a Mom is grounded on the principles of Cognitive-Behavior Therapy and incorporates the recent contributions of acceptance and compassion-based approaches (third-wave approaches) applied to the perinatal context. This study aimed to explore the processes underlying therapeutic change in the Be a Mom intervention, by: (1) exploring whether participation in the Be a Mom promotes the enhancement of self-regulatory skills (emotion regulation abilities, psychological flexibility and self-compassion) in comparison with women who did not participate in the program; and (2) exploring whether changes in self-regulatory skills are associated with changes in depressive symptoms, among women who participated in the Be a Mom program. Methods: A pilot randomized, two-arm controlled trial was conducted. Eligible women (presenting PPD risk-factors and/or early-onset PPD symptoms) were enrolled in the study and were randomly assigned to the intervention group (Be a Mom, n = 98) or to the waiting-list control group (n = 96). Participants in both groups completed baseline (T1) and post-intervention assessments (T2), including measures of depressive symptoms, emotion regulation abilities, psychological flexibility and self-compassion. Results: From baseline to post-intervention assessment, women in the intervention group showed a significantly greater decrease in the levels of emotion regulation difficulties (p < 0.001) and a significant greater increase in the levels of self-compassion (p < 0.001) compared to the control group. No significant differences were found concerning psychological flexibility. Moreover, a greater decrease in difficulties in emotion regulation and greater increase in self-compassion levels were significantly associated with a greater decrease in depressive symptoms, among women in the intervention group. Discussion: Be a Mom promotes the enhancement of women's emotion regulation abilities and self-compassion, and this seems to exert a protective effect in the presence of PPD risk factors (or early-onset symptoms) because it led to a reduction of depressive symptoms. By providing some insights into the processes that underlie treatment response to Be a Mom, this study highlights the important role of the targeted third-wave processes applied to the perinatal context.

Incidence of perineal pain and dyspareunia following spontaneous vaginal birth: a systematic review and meta-analysis

INTRODUCTION AND HYPOTHESIS

Perineal pain and dyspareunia are experienced by women undergoing a vaginal birth that can have short and longer term physical and psychological morbidities. This review aimed to determine the incidence of perineal pain and dyspareunia following spontaneous vaginal birth (SVB) with intact perineum, first and second-degree perineal trauma or episiotomy.

METHODS

Searches of MEDLINE, EMBASE, CINAHL, AMED and MIDIRS (inception - December 2017) were undertaken with selection criteria of any study evaluating the effect of intact perineum, first- or second-degree perineal trauma on perineal pain or dyspareunia in women with SVB.

RESULTS

Eighteen studies (8 RCTs and 10 NRSs) were included. Fourteen and 12 studies were undertaken to assess perineal pain and dyspareunia after SVB, respectively. Meta-analysis of 16 studies (3133 women) demonstrated that women at 2 days postpartum experienced nearly the same incidence of perineal pain whether perineal trauma existed or not. At 4-10 days postpartum there was a significant reduction in the incidence of perineal pain for both presence and absence of any perineal trauma. Episiotomy was associated with the highest rate of perineal pain. The incidence of dyspareunia was high at resumption of sexual intercourse following SVB with an intact perineum. At 12 months, women still experienced dyspareunia whether perineal trauma existed or not.

CONCLUSIONS

Women experience perineal pain and dyspareunia regardless of the presence or absence of perineal trauma after SVB; nonetheless, the reported incidence is higher if perineal trauma occurred.