Antenatal stress: an Irish case study

The mediating role of social support and resilience between self-efficacy and prenatal stress: a mediational analysis

BACKGROUND

Prenatal stress is a highly prevalent mental disorder experienced by pregnant women. This study assessed the prevalence and influencing factors of prenatal stress and investigated the mediating role of social support and resilience between self-efficacy and prenatal stress among pregnant women in China.

METHODS

A convenience sample comprising 1071 pregnant women from three hospitals in Nantong, Jiangsu Province, China, was recruited between February and June 2023. These participants completed a set of general survey questionnaires and were assessed using the Pregnancy Pressure Scale, Perceived Social Support Scale, the 10-item Connor-Davidson Resilience Scale, and the Chinese version of the General Self-Efficacy Scale. Furthermore, a hierarchical multiple regression model was employed to investigate the relevant factors and mediators of prenatal stress symptoms. A structural equation model was used to examine the mediating role of social support and resilience in the relationship between self-efficacy and prenatal stress.

RESULTS

The results of the multivariate regression analysis indicated significant associations between prenatal stress and parity, self-efficacy, social support, and resilience (P < 0.001). Self-efficacy accounted for 35.33% of the total effect, with a direct effect of -2.5306 (95% confidence interval [CI]: -4.0309 to -1,0303). Further examination through mediation analysis revealed the mediating roles of social support and resilience in the relationship between self-efficacy and prenatal stress. The mediating effect of social support was - 1.5933 (95% CI: -2.2907 to -0.9496), accounting for 22.24% of the total effect. Similarly, resilience exhibited a mediating effect of -3.0388 (95% CI: -4.3844 to -1.7135), accounting for 42.43% of the total effect.

CONCLUSION

The mediation analysis revealed that among pregnant women in China, the influence of self-efficacy on prenatal stress is channelled through social support and resilience. Therefore, enhancing social support, resilience, and self-efficacy might alleviate prenatal stress.

The experiences of women from culturally and linguistically diverse backgrounds with gestational diabetes mellitus: A mixed methods systematic review

BACKGROUND

Gestational diabetes mellitus (GDM) is experienced at a higher rate in women from culturally and linguistically diverse (CALD) backgrounds. The aim of this systematic review is to describe the experiences of women with GDM from CALD backgrounds and compare their experiences to women with GDM from non-CALD backgrounds.

MATERIALS AND METHODS

MEDLINE, EMBASE, PsycINFO, Scopus, WOS and CINAHL databases were searched for qualitative and quantitative studies which included data on the experiences of CALD background women with GDM during all stages of pregnancy. Quality appraisal utilized checklists for analytical cross-sectional studies and qualitative research. Thematic analysis was performed using nVivo software.

RESULTS

Of the 3054 studies identified, 24 studies met the inclusion criteria. Data synthesis produced five key themes: (1) Response to diagnosis, (2) Experiences with self-management, (3) Interactions with the healthcare system, (4) Mental health challenges and (5) Facilitators and barriers to support. Women with GDM from CALD and non-CALD backgrounds similarly expressed mental health challenges, feeling burdened by recommendations, and challenges interacting with healthcare professionals (HCP). The major difference in experience was the cultural relevance of recommendations, especially related to diet recommendations.

CONCLUSION

Gestational diabetes mellitus is a burdensome diagnosis for CALD and non-CALD women, with CALD women uniquely experiencing a lack of culturally relevant recommendations for self-management. The similarities and differences in experience call for optimisation of GDM management and support for women with GDM.

Evaluation of the association between fear of COVID-19 and pregnancy distress

Background

Mental health problems experienced during pregnancy negatively affect both maternal and fetal wellbeing.

Objective

This study aimed to investigate the relationship between fear of COVID-19 and pregnancy distress in healthy pregnant women living in Turkey.

Methods

A descriptive, relational/cross-sectional study was conducted by interviewing 363 pregnant women in person. Data were collected using a personal information form, the Fear of COVID-19 Scale (FCV-19S), and the Tilburg Pregnancy Distress Scale (TPDS).

Results

The mean FCV-19S score was 19.03±5.65 and the mean TPDS score was 19.97±7.97. According to the TPDS cut-off score, 19.0% of the participants were at risk of pregnancy distress. There was a significant positive correlation between FCV-19S and TPDS scores (r = 0.263, p<0.05). According to the regression analysis, age (β= -0.217), years of education (β= -0.272), and number of births (β= 0.502) were associated with fear of COVID-19, and fear of COVID-19 was associated with TPDS scores (β= 0.369) (p<0.05).

Conclusion

The pregnant women in this study had moderate fear of COVID-19. Compared to the literature data, the prevalence of pregnancy distress was slightly higher than pre-COVID-19 reports but quite low compared to other studies conducted during the pandemic.

Investigation of Psychosocial Health and Depression Levels of Pregnancy

Objective: The present study was conducted to examine the relationship between psychosocial health and depressive symptom levels of pregnant women.Methods: The data of 150 pregnant women who were followed up in the Family Healthcare Center were collected by face-to-face interview. The data were collected with study specific Personal Data Form, the Psychosocial Health Assessment in Pregnancy Scale (PHAPS), and Beck Depression Inventory (BDI).Results: The mean age of the pregnant participants was 27.49±5.69 years, and the mean marriage duration was 6.21±5.33 years and average number of pregnancies 2.50±1.58. Of the pregnant women participating in the study, 26.0% were in the first trimester, 34.7% were in the second trimester, and 39.3% were in the third trimester. The total mean score of the PHAPS during the pregnancies of the women was 2.06±0.6 and their psychosocial health status was poor. It was found that 23.3% of the pregnant women had mild, 8.7% had moderate, and 0.7% had severe depression symptoms.Conclusion: Negative and moderately significant relations were detected between better psychosocial health status and depression during pregnancy.

Relationship between historical developments in the percentages of low birthweight and fetal mortality in Spain

OBJECTIVE

To document the differences in low birthweight in different population subgroups and to analyze its possible relationship with fetal mortality rates in Spain.

METHOD

We used the microdata on live births and stillbirths since 1975 to 2020 from the Spanish National Statistics Institute to examine differentials in delivering a low birthweight controlling for different sociodemographic variables and to determine the relationship between low birthweight and fetal mortality. No statistical analysis was necessary beyond the calculation of percentages and rates.

RESULTS

The data at our disposal for Spain confirm the historical increase in the incidence of low birthweight and allow us to link trends in low birthweight with a decrease in the fetal mortality rate. When fetal mortality is high, the incidence of low birthweight is low, given that a natural selection effect takes place.

CONCLUSIONS

The surprising historical increase in the incidence of low birthweight in Spain can be explained by the improvement in mortality rates. As more fetuses of lower gestational age are born alive, cases of low birthweight also increase.

The Impact of Prepartum Depression and Birth Experience on Postpartum Mother-Infant Bonding: A Longitudinal Path Analysis

INTRODUCTION

Negative effects of impaired postpartum mother-infant-bonding on mental health of mothers, their newborn children and subsequent child development are well documented. Previous research demonstrated an association between a negative birth experience and postpartum mental health affecting postpartum mother-infant bonding. This study investigates the extent to which prepartum depression and birth experience influence the postpartum mental health of mothers and their bonding toward their newborns, and whether these influences differ according to parity and self-reported prior mental health problems.

METHOD

Three hundred and fifty-four women (18-43 years; M = 30.13, SD = 5.10) filled in the Edinburgh Postnatal Depression Scale (EPDS), the Maternal-Fetal Attachment Scale (MFAS), Salmon's Item List (SIL) assessing the birth experience, and the Postpartum Bonding Questionnaire (PBQ) at pre- and postpartum; they were also asked about birth complications and parity status.

RESULTS

Primipara reported significantly more birth complications (p = 0.048), with path analysis confirming this result (p < 0.001). Birth complications were associated with a more negative rating of the overall birth experience (p < 0.001). Mothers with self-reported prior mental health problems had higher prepartum depression scores (p < 0.001) but did not differ in other variables from mothers without prior self-reported mental health problems. Differences in depression scores between mothers with self-reported prior mental health problems and those without vanished at postpartum assessment (p > 0.05). Path-analysis highlighted the key role of postpartum depression, which was the only significant predictor of postpartum impairment in maternal-child bonding (p < 0.001). Birth experience and prepartum depression scores exerted an indirect effect on postpartum maternal-child bonding, mediated by postpartum depression.

DISCUSSION

The present study demonstrates the relevance of prepartum mental health of expectant mothers, especially of those who self-report prior mental health problems. The results support that reducing mental health problems of pregnant mothers might contribute to a more positive birth experience and potentially reduce postpartum depressive symptoms. As postpartum depression is associated with impaired parent-child bonding, such targeted interventions could promote child development. Group differences between primiparous and multiparous mothers suggest that the birth experience may be an influential factor for postpartum mental health.

Maternal mental health in the first year postpartum in a large Irish population cohort: the MAMMI study

PURPOSE

The international perinatal literature focuses on depression in the postpartum period. Prevalence and pathways of depression, anxiety and stress from pregnancy through the first postpartum year are seldom investigated.

METHODS

MAMMI is a prospective cohort study of 3009 first-time mothers recruited in pregnancy. Depressive, anxiety and stress symptoms measured using the Depression, Anxiety and Stress Scale (DASS 21) in pregnancy and at 3-, 6-, 9- and/or 12-months postpartum.

RESULTS

Prevalence of depressive and stress symptoms was lowest in pregnancy, increasing to 12-months postpartum. Anxiety symptoms remained relatively stable over time. In the first year after having their first baby, one in ten women reported moderate/severe anxiety symptoms (9.5%), 14.2% reported depression symptoms, and one in five stress symptoms (19.2%). Sociodemographic factors associated with increased odds of postpartum depression, anxiety and stress symptoms were younger age and being born in a non-EU country; socioeconomic factors were not living with a partner, not having postgraduate education and being unemployed during pregnancy. Retrospective reporting of poor mental health in the year prior to pregnancy and symptoms during pregnancy were strongly associated with poor postpartum mental health.

CONCLUSIONS

The current findings suggest that the current model of 6-week postpartum care in Ireland is insufficient to detect and provide adequate support for women's mental health needs, with long-term implications for women and children.

Pregnant women's daily patterns of well-being before and during the COVID-19 pandemic in Finland: Longitudinal monitoring through smartwatch technology

BACKGROUND

Technology enables the continuous monitoring of personal health parameter data during pregnancy regardless of the disruption of normal daily life patterns. Our research group has established a project investigating the usefulness of an Internet of Things-based system and smartwatch technology for monitoring women during pregnancy to explore variations in stress, physical activity and sleep. The aim of this study was to examine daily patterns of well-being in pregnant women before and during the national stay-at-home restrictions related to the COVID-19 pandemic in Finland.

METHODS

A longitudinal cohort study design was used to monitor pregnant women in their everyday settings. Two cohorts of pregnant women were recruited. In the first wave in January-December 2019, pregnant women with histories of preterm births (gestational weeks 22-36) or late miscarriages (gestational weeks 12-21); and in the second wave between October 2019 and March 2020, pregnant women with histories of full-term births (gestational weeks 37-42) and no pregnancy losses were recruited. The final sample size for this study was 38 pregnant women. The participants continuously used the Samsung Gear Sport smartwatch and their heart rate variability, and physical activity and sleep data were collected. Subjective stress, activity and sleep reports were collected using a smartphone application developed for this study. Data between February 12 to April 8, 2020 were included to cover four-week periods before and during the national stay-at-home restrictions. Hierarchical linear mixed models were exploited to analyze the trends in the outcome variables.

RESULTS

The pandemic-related restrictions were associated with changes in heart rate variability: the standard deviation of all normal inter-beat intervals (p = 0.034), low-frequency power (p = 0.040) and the low-frequency/high-frequency ratio (p = 0.013) increased compared with the weeks before the restrictions. Women's subjectively evaluated stress levels also increased significantly. Physical activity decreased when the restrictions were set and as pregnancy proceeded. The total sleep time also decreased as pregnancy proceeded, but pandemic-related restrictions were not associated with sleep. Daily rhythms changed in that the participants overall started to sleep later and woke up later.

CONCLUSIONS

The findings showed that Finnish pregnant women coped well with the pandemic-related restrictions and lockdown environment in terms of stress, physical activity and sleep.

The relationship between psychosocial health status and social support of pregnant women

PURPOSE

The aim of this study was to determine the relationship between psychosocial health status and social support, which has important effects on pregnancy, and to determine the factors related to both psychosocial health and social support.

METHOD

The research was planned to be a descriptive study. The sample of the study consisted of 393 pregnant women. 'Personal Information Form', 'Pregnancy Psychosocial Health Assessment Scale (PPHAS)', and 'Multidimensional Scale of Perceived Social Support (MSPSS)' were used to collect data, and Student's t-test, ANOVA and Tukey's HSD tests were used for the data analysis. The relationship between the two continuous variables was evaluated according to the Pearson correlation coefficient.

RESULTS

Psychosocial health conditions and perceived social supports of pregnant women whose spouses were working were determined to be significantly higher (p < .05), and at a lower level (p < .05) in pregnant women with two or more children. As MSPSS total mean scores of the pregnant women increased, their PPHAS total mean scores were weakly affected in the positive direction (r = 0.393, p < .01).

CONCLUSIONS

It is recommended that health care needs of pregnant women should be evaluated not only in terms of physical health but also together with their psychosocial health and social supports. Furthermore, this assessment should be done in their own home environment with their spouses and other family members.

Allergic disease and risk of stress in pregnant women: a PreventADALL study

Background

Maternal stress during pregnancy may negatively affect the health of mother and child. We therefore aimed to identify the proportion of women reporting high maternal stress in mid and late pregnancy and explore whether symptoms of maternal allergic disease are associated with perceived maternal stress in late pregnancy.

Method

The population-based Preventing Atopic Dermatitis and Allergy in Children (PreventADALL) study enrolled 2697 pregnant women at their 18-week routine ultrasound examination in Norway and Sweden. Information about sociodemographic factors, symptoms and doctor-diagnosed asthma, allergic rhinitis, atopic dermatitis, food allergy, and anaphylaxis and stress using the 14-item perceived stress scale (PSS) was collected at 18 weeks (mid) and 34 weeks (late) pregnancy. High stress was defined as a PSS score ≥29. Scores were analysed using multivariate logistic and linear regression.

Results

Among the 2164 women with complete PSS data, 17% reported asthma, 20% atopic dermatitis, 23% allergic rhinitis, 12% food allergy and 2% anaphylaxis. The proportion of women reporting high stress decreased from 15% at mid to 13% at late pregnancy (p<0.01). The adjusted odds ratio for high stress in late pregnancy was 2.25 (95% CI 1.41-3.58) for self-reported symptoms of asthma, 1.46 (95% CI 1.02-2.10) for allergic rhinitis and 2.25 (95% CI 1.32-3.82) for food allergy. A multivariate linear regression model confirmed that symptoms of asthma (β coefficient 2.11; 0.71-3.51), atopic dermatitis (β coefficient 1.76; 0.62-2.89) and food allergy (β coefficient 2.24; 0.63-3.84) were independently associated with increased PSS score.

Conclusion

Allergic disease symptoms in pregnancy were associated with increased stress, highlighting the importance of optimal disease control in pregnancy.

A cross-sectional study on maternal anxiety levels after cytomegalovirus screening

Purpose: we aimed to estimate the anxiety levels of pregnant women following maternal serum screening for CMV infection.Materials and methods: In this case-control study conducted from April 2016 to June 2017, we enrolled all pregnant women referred to our hospital who were CMV immunoglobulin (Ig) M antibody positive (IgM-positive group, n = 51); further, those who were CMV IgG positive but IgM negative (IgM-negative group, n = 51) during the same period were included as study controls. Data were collected on patient characteristics, CMV IgM levels, and whether patients were accompanied by their partners during the first hospital visit after CMV IgM testing. The State-Trait Anxiety Inventory was used to assess anxiety levels.Results: Both groups were age matched [mean age (years): IgM-positive, 30 ± 4.2 and IgM-negative, 29.9 ± 4.6]. The mean state-anxiety score was higher in the IgM-positive group (53 ± 9.6) than in the IgM-negative group (38.5 ± 7.0, p < .05) with no between-group differences in trait-anxiety scores. Similarly, a higher number of women were accompanied by their partners in the IgM-positive group. The state-anxiety scores and CMV IgM levels were not correlated in the IgM-positive group.Conclusion: Counseling support is essential for IgM-positive pregnant women following serum screening, and the screening should be avoided if support systems are unavailable.

Perinatal mental health in Ireland: A scoping review

BACKGROUND

The international literature clearly indicates that perinatal mental health issues affect many women, and can have profound negative consequences for both the mother, infant and family, and that the causes of perinatal mental health issues are multifaceted and complex.

AIM

This scoping review explores the existing research on perinatal mental health in Ireland to provide a baseline and to guide further research as well as inform the implementation of the recent policy strategies.

DESIGN

Scoping Review METHODS: We conducted a structured literature search on Science Direct, Web of Science, PubMed, PsychInfo and Scopus, using key words to search for publications up to December 2018. All publications based on empirical studies on perinatal mental health in Ireland (regardless of research design, sample size, and methods used) were included. Exclusion criteria were: study location not the Republic of Ireland; not relating to the perinatal period (pregnancy up to the first 12 months after birth); not relating to mental health; and not relating to maternal mental health, not relating to human subjects; not an empirical study; international study with generalised results. Data were mapped onto a charting form, allowing us to a) conduct a basic numerical analysis of prevalent research questions and designs, and b) to identify key themes within the data, utilising Braun and Clarke's (2006) thematic analysis.

RESULTS

The search resulted in 623 unique references. 29 publications were included in this review. Our analysis resulted in three main findings. (1) A significant number of women in Ireland are affected by perinatal mental health problems, but prevalence rates vary significantly between studies. (2) A history of mental health problems and lack of social support were identified as key risk factors. (3) The existing perinatal mental health services in Ireland are generally inadequate. We further noted a focus on quantitative approaches and a medicalisation of perinatal mental health, resulting in an absence of women's voices and their lived experiences, particularly those of women of colour, migrant women and ethnic minorities.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

We conclude that in order to further the vision of woman-centred maternity care, we need to conduct woman-centred research that puts women's subjective experiences of perinatal mental health and well-being at the centre, including those of marginalised women in an increasingly diverse Irish society.

Women's experiences of a diagnosis of gestational diabetes mellitus: a systematic review

Background

Gestational diabetes mellitus (GDM) - a transitory form of diabetes induced by pregnancy - has potentially important short and long-term health consequences for both the mother and her baby. There is no globally agreed definition of GDM, but definition changes have increased the incidence in some countries in recent years, with some research suggesting minimal clinical improvement in outcomes. The aim of this qualitative systematic review was to identify the psychosocial experiences a diagnosis of GDM has on women during pregnancy and the postpartum period.

Methods

We searched CINAHL, EMBASE, MEDLINE and PsycINFO databases for studies that provided qualitative data on the psychosocial experiences of a diagnosis of GDM on women across any stage of pregnancy and/or the postpartum period. We appraised the methodological quality of the included studies using the Critical Appraisal Skills Programme Checklist for Qualitative Studies and used thematic analysis to synthesis the data.

Results

Of 840 studies identified, 41 studies of diverse populations met the selection criteria. The synthesis revealed eight key themes: initial psychological impact; communicating the diagnosis; knowledge of GDM; risk perception; management of GDM; burden of GDM; social support; and gaining control. The identified benefits of a GDM diagnosis were largely behavioural and included an opportunity to make healthy eating changes. The identified harms were emotional, financial and cultural. Women commented about the added responsibility (eating regimens, appointments), financial constraints (expensive food, medical bills) and conflicts with their cultural practices (alternative eating, lack of information about traditional food). Some women reported living in fear of risking the health of their baby and conducted extreme behaviours such as purging and starving themselves.

Conclusion

A diagnosis of GDM has wide reaching consequences that are common to a diverse group of women. Threshold cut-offs for blood glucose levels have been determined using the risk of physiological harms to mother and baby. It may also be advantageous to consider the harms and benefits from a psychosocial and a physiological perspective. This may avoid unnecessary burden to an already vulnerable population.

Psychosocial factors correlate with fatigue among pregnant women in Jordan

PURPOSE

The study aimed to assess the correlation between fatigue and psychological factors, namely stress, social support, self-esteem, and depression among pregnant women in Jordan.

DESIGN AND METHODS

A cross-sectional design was suggested. Cluster stratified random sampling technique was adopted. Fatigue assessment scale, Rosenberg Self-Esteem Scale, Perceived Stress Scale, Multidimensional Social Support Scale, and Beck's Depression Inventory were used.

FINDINGS

A total of 580 pregnant women were included. Overall, 67.4% of the participants experienced fatigue, about 74.0% had moderate to high stress, 56.0% had moderate social support, around 89.0% had normal self-esteem, and 43.1% experienced moderate to extreme depression. Stress, self-esteem, and depression were correlated with fatigue.

PRACTICE IMPLICATIONS

This study can help develop proper psychosocial care and sustain mental health among women during pregnancy.

Systematic Review of Prevalence of Antepartum Depression during the Trimesters of Pregnancy

BACKGROUND

Depression is prevalent during antenatal and postnatal stages of pregnancy. The effect of depression can be seen in complications during and after pregnancy, fetal growth retardation, abortions and preterm births. The literature abounds on postpartum depression (PD) while few studies are on antepartum depression (AD).

AIM

The systematic review aims to compute the prevalence of AD from published articles.

MATERIAL AND METHODS

The published articles (26) used in this review were obtained from the search of the search keywords "Depressive conditions in pregnancy AND trimesters". All the articles were considered irrespective of language and their citation status as of the time of the query. Only articles that presented the prevalence mean and sample size were included. Articles on questionnaires filled by nonpregnant women and men were excluded. Articles that presented the prevalence of depression for the postpartum period only were excluded but were included if they addressed depression at both postpartum and trimester(s) of pregnancy. P-value of less than or equal to 0.05 was considered significant.

RESULTS

Analysis of the 26 articles showed that 4,303 subjects tested positive for depression in a sample of 28,248 pregnant mothers, giving the prevalence rate as 15%. Confounding was removed, and the sample size was adjusted to be 25,771 and 4,223 were screened to have depressive symptoms, thereby giving a new prevalence rate as 16.4%. It was also revealed that AD is most prevalent in the last trimester of pregnancy and least in the second trimester. Pregnancy duration and PD are not correlated with AD. This implies that AD can be observed in any period of the pregnancy and cannot predict the incidence of PD.

CONCLUSION

Efforts must be intensified to monitor pregnant women during the third trimester to reduce the incidence of maternal depression during pregnancy, thereby reducing the prevalence.

The Correlation between Islamic Lifestyle and Pregnancy-Specific Stress: A Cross-Sectional, Correlational Study

BACKGROUND

Pregnancy is associated with great psychological, emotional and physical stress. In addition to undergoing hormonal changes, pregnant women experience a change in their attitude toward life and learn to re-assess their skills and lifestyle. Lifestyle, in general, and Islamic lifestyle, in particular, is concerned with the different psychological, social and physical aspects of the individual's life.

AIM

This study was conducted to evaluate the correlation between Islamic lifestyle and pregnancy-specific stress in pregnant women.

MATERIAL AND METHODS

This cross-sectional, correlational study was conducted on 300 pregnant women presenting to prenatal care clinics. Data were collected using a demographic, the Islamic lifestyle and the pregnancy-related stress questionnaires.

RESULTS

The results showed a statistically significant negative correlation (r = -0.284) between Islamic lifestyle and pregnancy-specific stress (P < 0.01). The stepwise regression showed that the mean score obtained in the pregnancy-related stress questionnaire decreased by 0.75 per year of marriage and by 0.14 per point in the Islamic lifestyle questionnaire.

CONCLUSION

There was a significant negative correlation between Islamic lifestyle and pregnancy-specific stress. Training mothers, raising their awareness and encouraging them to adopt an Islamic lifestyle may play a significant role in controlling pregnancy-specific stress.

Electronic-based lifestyle interventions in overweight or obese perinatal women: a systematic review and meta-analysis

Electronic-based (e-based) lifestyle interventions provide potential and cost-effective delivery of remote interventions for overweight and obese perinatal women. To date, no meta-analysis has reported the efficacy of maternal and neonatal outcomes. Seven electronic databases were searched from inception up to July 13, 2016, including the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, EMBASE, ProQuest Dissertations and Theses, PsycINFO, PubMed and Scopus. Among the 1,145 studies retrieved, 14 randomized controlled trials were selected among 17 publications. The Cochrane risk of bias tool was used to appraise the quality assessment. The meta-analyses demonstrated a significant result for limiting gestational weight gain, losing postnatal weight in 1-2 months, increasing self-reported moderate and vigorous physical activity and reducing caloric intake using diet-related software. Our review shows that an e-based lifestyle intervention is an acceptable approach. The findings reveal the variability in intervention methods and provide limited conclusive evidence. Thus, future studies should examine the efficacy and essential components as well as the various approaches using optimal portions of in-person and phone sessions. Further evaluations comparing the effectiveness of different e-based lifestyle intervention approaches toward activity-related and diet-related outcomes are necessary.

Therapist-Supported Internet-Based Cognitive Behavior Therapy for Stress, Anxiety, and Depressive Symptoms Among Postpartum Women: A Systematic Review and Meta-Analysis

Background

A growing number of meta-analyses have supported the application of therapist-supported Internet-based cognitive behavior therapy (iCBT) for psychological disorders across different populations, but relatively few meta-analyses have concentrated on postpartum women.

Objective

This meta-analysis evaluated the efficacy of therapist-supported iCBT in improving stress, anxiety, and depressive symptoms among postpartum women.

Methods

A total of 10 electronic databases were used to search for published and unpublished trials. Cochrane Collaboration tool for assessing risk of bias was utilized to measure methodological quality. Meta-analysis was performed using the RevMan software (Review Manager version 5.3 for Windows from the Nordic Cochrane Centre, the Cochrane Collaboration, 2014). Among the 789 studies identified, 8 randomized controlled trials were selected, involving 1523 participants across 6 countries.

Results

More than half (65%) of the eligible studies had a low risk of bias with no heterogeneity. Results revealed that therapist-supported iCBT significantly improved stress (d=0.84, n=5), anxiety (d=0.36, n=6), and depressive symptoms (d=0.63, n=8) of the intervention group compared with those of the control group at post-intervention.

Conclusions

This review revealed that therapist-supported iCBT significantly improves stress, anxiety, and depressive symptoms among postpartum women with small to large effects. Future effectiveness studies should establish the essential components, format, and approach of iCBT with optimal levels of human support to maximize a long-term effect.

Impact of the global financial crisis on low birth weight in Portugal: a time-trend analysis

Background

The 2007–2008 global financial crisis had adverse consequences on population health of affected European countries. Few contemporary studies have studied its effect on perinatal indicators with long-lasting influence on adult health. Therefore, in this study, we investigated the impact of the 2007–2008 global financial crisis on low birth weight (LBW) in Portugal.

Methods

Data on 2 045 155 singleton births of 1995–2014 were obtained from Statistics Portugal. Joinpoint regression analysis was performed to identify the years in which changes in LBW trends occurred, and to estimate the annual per cent changes (APC). LBW risk by time period expressed as prevalence ratios were computed using the Poisson regression. Contextual changes in sociodemographic and economic factors were provided by their trends.

Results

The joinpoint analysis identified 3 distinct periods (2 jointpoints) with different APC in LBW, corresponding to 1995–1999 (APC=4.4; 95% CI 3.2 to 5.6), 2000–2006 (APC=0.1; 95% CI −050 to 0.7) and 2007–2014 (APC=1.6; 95% CI 1.2 to 2.0). For non-Portuguese, it was, respectively, 1995–1999 (APC=1.4; 95% CI −3.9 to 7.0%), 2000–2007 (APC=−4.2; 95% CI −6.4 to −2.0) and 2008–2014 (APC=3.1; 95% CI 0.8 to 5.5). Compared with 1995–1999, all specific maternal characteristics had a 10–15% increase in LBW risk in 2000–2006 and a 20–25% increase in 2007–2014, except among migrants, for which LBW risk remained lower than in 1995–1999 but increased after the crisis. The increasing LBW risk coincides with a deceleration in gross domestic product growth rate, reduction in health expenditure, social protection allocation on family/children support and sickness.

Conclusions

The 2007–2008 global financial crisis was associated with a significant increase in LBW, particularly among infants of non-Portuguese mothers. We recommend strengthening social policies aimed at maternity protection for vulnerable mothers and health system maintenance of social equity in perinatal healthcare.

Different perceptions of stress, coping styles, and general well-being among pregnant Chinese women: a structural equation modeling approach

Few studies have examined different perceptions of stress or explored the positive aspects of well-being among pregnant Chinese women, so there is a need to explore these phenomena in order to fill the research gap. The aim of this study was to examine the relationships among the different perceptions of stress, coping styles, and general well-being using a structural equation modeling approach. We examined a hypothetical model among 755 pregnant Chinese women based on the integration of theoretical models. The Perceived Stress Scale (PSS), the Trait Coping Styles Questionnaire (TCSQ), and the General Well-Being Schedule (GWB) were used to measure perceived stress, coping styles, and general well-being, respectively. A structural equation model showed that positive and negative perceptions of stress significantly influenced positive and negative coping styles, respectively. Different perceptions of stress were significantly associated with general well-being, but different coping styles had no significant effects on general well-being. The model had a good fit to the data (IFI = 0.910, TLI = 0.904, CFI = 0.910, and RMSEA = 0.038). Different perception of stress was able to predict significant differences in coping styles and general well-being.

Is the economic crisis affecting birth outcome in Spain? Evaluation of temporal trend in underweight at birth (2003-2012)

BACKGROUND

There is growing evidence of the impact of the current European economic crisis on health. In Spain, since 2008, there have been increasing levels of impoverishment and inequality, and important cuts in social services.

AIM

The objective is to evaluate the impact of the economic crisis on underweight at birth in Spain.

METHOD

Trends in underweight at birth were examined between 2003 and 2012. Underweight at birth is defined as a singleton, term neonatal weight lesser than -2 SD from the median weight at birth for each sex estimated by the WHO Standard Growth Reference. Using data from the Statistical Bulletin of Childbirth, 2 933 485 live births born to Spanish mothers have been analysed. Descriptive analysis, seasonal decomposition analysis and crude and adjusted logistic regression including individual maternal and foetal variables as well as exogenous economic indicators have been performed.

RESULTS AND CONCLUSIONS

Results demonstrate a significant increase in the prevalence of underweight at birth from 2008. All maternal-foetal categories were affected, including those showing the lowest prevalence before the crisis. In the full adjusted logistic regression, year-on-year GDP per capita remains predictive on underweight at birth risk. Previous trends in maternal socio-demographic profiles and a direct impact of the crisis are discussed to explain the trends described.

Examining Factor Structure and Validating the Persian Version of the Pregnancy's Worries and Stress Questionnaire for Pregnant Iranian Women

BACKGROUND AND OBJECTIVES

Pregnant women tend to experience anxiety and stress when faced with the changes to their biology, environment and personal relationships. The identification of these factors and the prevention of their side effects are vital for both mother and fetus. The present study was conducted to validate and to examine the factor structure of the Persian version of the Pregnancy's Worries and Stress Questionnaire.

MATERIALS AND METHODS

The 25-item PWSQ was first translated by specialists into Persian. The questionnaire's validity was determined using face, content, criterion and construct validity and reliability of questionnaire was examined using Cronbach's alpha. Confirmatory factor analysis was performed in AMOS and SPSS 21. Participants included healthy Iranian pregnant women (8-39 weeks) who refer to selected hospitals for prenatal care. Hospitals included private, social security and university hospitals and selected through the random cluster sampling method.

FINDINGS

The results of validity and reliability assessments of the questionnaire were acceptable. Cronbach's alpha calculated showed a high internal consistency of 0.89. The confirmatory factor analysis using the c2, CMIN/DF, IFI, CFI, NFI and NNFI indexes showed the 6-factor model to be the best fitted model for explaining the data.

CONCLUSION

The questionnaire was translated into Persian to examine stress and worry specific to Iranian pregnant women. The psychometric results showed that the questionnaire is suitable for identifying Iranian pregnant women with pregnancy-related stress.