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Warmelink JC, Marissink L, Kroes L, Ranjbar F, Henrichs J. What are antenatal maternity care needs of women who conceived through fertility treatment?: a mixed methods systematic review. J Psychosom Obstet Gynaecol 2023; 44:2148099. [PMID: 36508566 DOI: 10.1080/0167482x.2022.2148099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Existing research indicates that pregnant women who conceived through fertility treatment might experience more stress and anxiety compared to women who conceived spontaneously. Therefore, these women might have additional antenatal care needs. METHODS A search for both quantitative and qualitative studies was performed in PubMed, PsycINFO, CINAHL and MEDLINE through May 2021, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. 21 articles met the inclusion criteria. After methodological quality appraisal using the Mixed Methods Appraising Tool, 15 studies were included in the review. RESULTS Analysis of the studies identified behavioral, relational/social, emotional, and cognitive needs and women's preference about maternity care. Women who conceived through fertility treatment reported lower social and physical functioning scores and elevated levels of anxiety and depression compared to women who conceived spontaneously. They reported difficulties adjusting to pregnancy and experienced a care gap between discharge from the fertility clinic and going to local maternity care services for their first consultation, and a care gap postpartum. CONCLUSIONS Women who conceived through fertility treatment have additional antenatal care needs. We recommend to offer these women more frequent check-ins, and to pay attention to the impact of their infertility and treatment on their pregnancy.
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Affiliation(s)
- J Catja Warmelink
- Department of General Practice and Elderly Care Medicine, Section Midwifery Science AVAG, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Midwifery Science, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Midwifery Academy Amsterdam/Groningen, Groningen, The Netherlands
| | - Lisa Marissink
- Midwifery Academy Amsterdam/Groningen, Groningen, The Netherlands.,Midwifery Practice Liberis Libenter, Enschede, The Netherlands
| | - Linda Kroes
- Midwifery Academy Amsterdam/Groningen, Groningen, The Netherlands.,Midwifery Practice De vroedschap, Oosterwolde, The Netherlands.,Midwifery Practice De morgen, Dalfsen, The Netherlands
| | - Fahimeh Ranjbar
- Nursing and Midwifery Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Jens Henrichs
- Department of Midwifery Science, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Slavov S, Ingilizova G, Yaneva G. Analysis of Delivery in Singleton Pregnancies Achieved by In Vitro Fertilization. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Birth after IVF is increasingly observed in modern obstetrics, so knowledge of its features is of paramount importance for clinical practice.
AIM: The purpose of our study was to compare IVF and spontaneous singleton pregnancies in terms of cesarean section rate, operative vaginal birth rate, induction of labor, manual removal of the placenta in vaginal births, severe PPH and need for blood transfusion after delivery.
MATERIAL AND METHODS: We conducted a retrospective study at "Maichin Dom" University Hospital in Sofia, Bulgaria for the period from January 2013 to December 2017 and analyzed 402 singleton IVF pregnancies and compared them with 523 spontaneous singleton pregnancies
RESULTS: We found a significantly higher rate of cesarean sections in IVF compared to spontaneous pregnancies [OR 1.73; 95% CI 1.4-2.14; p<0.001]. Vaginal delivery after IVF is associated with a higher incidence of operative vaginal delivery than spontaneous pregnancies [OR 2.27; 95% CI 1.14 - 4.52; p=0.018]. No statistical differences in rates of labor induction and manual removal of the placenta between two groups were estimated (p>0.05). Severe PPH and blood transfusions were three times higher in patients after IVF undergoing a cesarean section than in those with spontaneous singleton pregnancies [OR 3.0; 95% CI 1.11 - 8.11; p=0.018].
CONCLUSION: IVF singleton pregnancies are associated with a higher risk of cesarean section as well as some obstetric complications. Obstetricians should treat these pregnancies with caution in order to reduce cesarean section rate and improve the outcome.
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Maehara K, Iwata H, Kimura K, Mori E. Experiences of transition to motherhood among pregnant women following assisted reproductive technology: a qualitative systematic review. JBI Evid Synth 2021; 20:725-760. [PMID: 34410230 DOI: 10.11124/jbies-20-00545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This systematic review aimed to identify and synthesize available qualitative evidence regarding the experiences of the transition to motherhood among pregnant women following assisted reproductive technology. INTRODUCTION Pregnant women following assisted reproductive technology experience unique challenges to their identity when transitioning to motherhood. It is important that health care professionals understand the context and complexity of emotional adaptation to pregnancy following assisted reproductive technology. INCLUSION CRITERIA Any qualitative data from empirical studies that described experiences of the transition to motherhood during pregnancy among women who conceived through assisted reproductive technology were considered for inclusion. METHODS Several databases were searched for published and unpublished studies in English or Japanese from 1992 to 2019, including MEDLINE, CINAHL, PsycINFO, ProQuest Health and Medical Collection, Google Scholar, and Open Access Theses and Dissertations (in English); and Ichushi-Web, CiNii, and the Institutional Repositories Database (in Japanese). All included studies were assessed by two independent reviewers. Any disagreements were resolved through discussion. We used the recommended JBI approach to critical appraisal, data extraction, and data synthesis. RESULTS This review included seven studies that considered pregnant women's (n = 110) experiences of transition to motherhood following assisted reproductive technology, and were assessed as moderate to high quality (scores 7-10) based on the JBI critical appraisal checklist for qualitative research. All studies used qualitative methodologies or methods including phenomenology, narrative approach, qualitative description, and qualitative content analysis. There were two studies from Japan, one from Brazil, one from Iran, one from Israel, one from the UK, and one from the USA. In total, 51 supported findings were aggregated into 14 categories, and five synthesized findings: i) Pregnant women following assisted reproductive technology require support to decrease anxiety and improve their belief in pregnancy to internalize a maternal identity; ii) Pregnant women following assisted reproductive technology need reassurance of their lifestyles to ensure a safe passage through pregnancy because of ambivalent feelings about becoming a mother; iii) Pregnant women following assisted reproductive technology develop a maternal identity with affection for the fetus if they switch their mindset from infertility to pregnancy; iv) Pregnant women following assisted reproductive technology need to review their self-image of being infertile and prepare for childbirth or motherhood; v) Pregnancy following assisted reproductive technology contributes to the emergence of positive feelings and changing the women's sense of self and other personal relationships. Based on the ConQual approach, the confidence in the synthesized findings was rated as moderate to low. CONCLUSIONS The synthesized findings highlight the importance of understanding the uncertainty and ambivalent feelings women have about their pregnancy, delayed development of attachment to their fetus and formation of a maternal identity, alteration in their relationships, and the social context of pregnancy via assisted reproductive technology among pregnant women following assisted reproductive technology. Health care professionals need to be aware of the specific care needs relating to the unique pathway in the identity transition to motherhood following assisted reproductive technology for these women. More research on development and implementation of specific intervention programs for expectant mothers following assisted reproductive technology is needed. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019138200.
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Affiliation(s)
- Kunie Maehara
- Graduate School of Nursing, Chiba University, Chiba, Japan The Chiba University Centre for Evidence Based Practice: A JBI Affiliated Group, Chiba, Japan
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Ranjbar F, Warmelink JC, Gharacheh M. Prenatal attachment in pregnancy following assisted reproductive technology: a literature review. J Reprod Infant Psychol 2019; 38:86-108. [PMID: 31852259 DOI: 10.1080/02646838.2019.1705261] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective: To summarise the literature on prenatal attachment in pregnancies following Assisted Reproductive Technology (ART).Background: Prenatal attachment can predict the quality of the postpartum parent-infant relationship and is linked to perinatal mental health of the parents and their adjustment to the parental role. It might be expected prenatal attachment will be influenced by fertility treatment such as ART, but there are contradictory results.Methods: In this review, studies with a cross-sectional and longitudinal design, published in 1990-2019 were included. A search was conducted in MEDLINE/PubMed, EMbase, Web of Science and Scopus, and using the Google Scholar search engine. A total of 17 articles were found which met the inclusion criteria and after these articles were reviewed using the STROBE-checklist, 15 articles were included in the study.Results: In most couples who conceived following ART, the level of prenatal attachment was either similar to or higher than in couples who conceive without ART.Conclusions: The findings challenge the idea that infertility problems affect attachment in pregnancies following ART. However, ART- couples may be more susceptible to anxiety due to pregnancy loss and support may be better focused on the pregnancy-related anxiety in these couples rather than any attachment intervention.
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Affiliation(s)
- Fahimeh Ranjbar
- Nursing Care Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - J Catja Warmelink
- Department of Midwifery Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Department of General Practice & Elderly Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.,AVAG (Amsterdam/Groningen Midwifery Academy), Groningen, The Netherlands
| | - Maryam Gharacheh
- Nursing Care Research Centre, Iran University of Medical Sciences, Tehran, Iran
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Maehara K, Iwata H, Kosaka M, Kimura K, Mori E. Experiences of transition to motherhood among pregnant women following assisted reproductive technology: a systematic review protocol of qualitative evidence. JBI Evid Synth 2019; 18:74-80. [PMID: 31524649 DOI: 10.11124/jbisrir-d-19-00071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This systematic review aims to identify and synthesize available qualitative evidence related to the experiences of transition to motherhood during pregnancy in women who conceived through assisted reproductive technology (ART). INTRODUCTION Women who conceived through ART experience pregnancy-specific anxiety and paradoxical feelings, and face unique challenges in their identity transition to motherhood. It is important for healthcare professionals working with these women to understand the context and complexity of this special path to parenthood, including the emotional adaptation to pregnancy following ART. A qualitative systematic review can provide the best available evidence to inform development of nursing interventions to meet the needs of pregnant women after ART. INCLUSION CRITERIA This review will consider any qualitative research data from empirical studies published from 1992-2019 in English or Japanese that described experiences of transition to motherhood during pregnancy in women who conceived with ART. METHODS This review will follow the JBI approach for qualitative systematic reviews. Databases that will be searched for published and unpublished studies include MEDLINE, CINAHL, PsycINFO, ProQuest Health & Medical Collection, Google Scholar and Open Access Theses and Dissertations (in English), and Ichushi-Web, CiNii and the Institutional Repositories Database (in Japanese). Titles and abstracts will be screened by two independent reviewers in full. The full-text of selected studies will be assessed in detail, and findings and their illustrations will be extracted and aggregated. Any disagreements between the reviewers that arise at each stage will be resolved through discussion, or by a third reviewer.
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Affiliation(s)
- Kunie Maehara
- Graduate School of Nursing, Chiba University, Chiba, Japan.,The Chiba University Centre for Evidence Based Practice: a Joanna Briggs Institute Affiliated Group
| | - Hiroko Iwata
- Graduate School of Nursing, Chiba University, Chiba, Japan.,The Chiba University Centre for Evidence Based Practice: a Joanna Briggs Institute Affiliated Group
| | - Mai Kosaka
- Graduate School of Nursing, Chiba University, Chiba, Japan.,The Chiba University Centre for Evidence Based Practice: a Joanna Briggs Institute Affiliated Group
| | - Kayoko Kimura
- Graduate School of Nursing, Chiba University, Chiba, Japan.,The Chiba University Centre for Evidence Based Practice: a Joanna Briggs Institute Affiliated Group
| | - Emi Mori
- Graduate School of Nursing, Chiba University, Chiba, Japan.,The Chiba University Centre for Evidence Based Practice: a Joanna Briggs Institute Affiliated Group
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Boz İ, Özçetin E, Teskereci G. İnfertilitede Anne Olma: Kuramsal Bir Analiz. PSIKIYATRIDE GUNCEL YAKLASIMLAR 2018. [DOI: 10.18863/pgy.382342] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Salih Joelsson L, Tydén T, Wanggren K, Georgakis MK, Stern J, Berglund A, Skalkidou A. Anxiety and depression symptoms among sub-fertile women, women pregnant after infertility treatment, and naturally pregnant women. Eur Psychiatry 2017; 45:212-219. [PMID: 28957789 DOI: 10.1016/j.eurpsy.2017.07.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 06/27/2017] [Accepted: 07/08/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Infertility has been associated with psychological distress, but whether these symptoms persist after achieving pregnancy via assisted reproductive technology (ART) remains unclear. We compared the prevalence of anxiety and depressive symptoms between women seeking for infertility treatment and women who conceived after ART or naturally. METHODS Four hundred and sixty-eight sub-fertile non-pregnant women, 2972 naturally pregnant women and 143 women pregnant after ART completed a questionnaire in this cross-sectional study. The Anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A≥8) and Edinburgh Postnatal Depression Scale (EPDS≥12) were used for assessing anxiety and depressive symptoms, respectively. Multivariate Poisson regression models with robust variance were applied to explore associations with anxiety and depressive symptoms. RESULTS The prevalence of anxiety and depressive symptoms among sub-fertile, non-pregnant women (57.6% and 15.7%, respectively) were significantly higher compared to women pregnant after ART (21.1% and 8.5%, respectively) and naturally pregnant women (18.8% and 10.3%, respectively). History of psychiatric diagnosis was identified as an independent risk factor for both anxiety and depressive symptoms. The presence of at least one unhealthy lifestyle behavior (daily tobacco smoking, weekly alcohol consumption, BMI≥25, and regular physical exercise<2h/week) was also associated with anxiety (Prevalence Ratio, PR: 1.24; 95%CI: 1.09-1.40) and depressive symptoms (PR: 1.25; 95%CI: 1.04-1.49). CONCLUSIONS Women pregnant after ART showed no difference in anxiety and depressive symptoms compared to naturally pregnant women. However, early psychological counseling and management of unhealthy lifestyle behaviors for sub-fertile women may be advisable, particularly for women with a previous history of psychiatric diagnosis.
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Affiliation(s)
- L Salih Joelsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - T Tydén
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - K Wanggren
- Department of Clinical Science, Intervention and Technology, Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
| | - M K Georgakis
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Sweden
| | - J Stern
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Health Promotion, Sophiahemmet University, Stockholm, Sweden
| | - A Berglund
- The National Centre for Knowledge of Men's Violence against Women, Uppsala University, Uppsala, Sweden
| | - A Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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Antenatal needs of couples following fertility treatment: a qualitative study in primary care. Br J Gen Pract 2016; 65:e570-7. [PMID: 26324493 DOI: 10.3399/bjgp15x686473] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND It is known that couples may experience emotional distress while undergoing infertility treatment, but less is known about their experience of pregnancy following successful conception. Typically, couples are discharged from the fertility clinic to receive standard antenatal care. Recent research has raised questions about whether this care adequately meets their needs. AIM To explore the antenatal experiences of females and males who have successfully conceived through infertility treatment. DESIGN AND SETTING An exploratory qualitative approach was undertaken, using individual, in-depth interviews with females and males who had successfully undergone infertility treatment in one of three fertility clinics in the south of England. METHOD Twenty participants were interviewed (12 females and eight male partners) when their pregnancy had reached 28 weeks' gestation. Participants were asked about their experiences of infertility treatment, pregnancy, and antenatal care. Interviews were audiorecorded, transcribed, and analysed thematically. RESULTS Analysis of the interviews suggested females and males experienced a 'gap' in their care, in terms of time and intensity, when discharged from the fertility clinic to standard antenatal care. This gap, combined with their previous experience of infertility treatment, heightened their fear of pregnancy loss and increased their need for support from their health professionals. Participants' previous experience of infertility treatment also appeared to deter them from preparing for the birth and parenthood, and disclosing negative feelings to others about the pregnancy. CONCLUSION Females and males who have successfully undergone infertility treatment may require additional support in primary care to address anxiety during pregnancy, enable disclosure of negative feelings, and to help them prepare for childbirth and parenthood.
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Warmelink JC, Adema W, Pranger A, de Cock TP. Client perspectives of midwifery care in the transition from subfertility to parenthood: a qualitative study in the Netherlands. J Psychosom Obstet Gynaecol 2016; 37:12-20. [PMID: 26595088 PMCID: PMC4743598 DOI: 10.3109/0167482x.2015.1106474] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Pregnancy, childbirth and the postpartum period after fertility treatment are considered "normal" in the Netherlands, with no indication of an increased obstetric risk, and can therefore be monitored by a primary care midwife. However, there is little evidence on the experiences of couples and women who finally get pregnant after fertility treatment and a lack of training for midwives exists on this subject. The aim of this study was to map the midwifery care needs of the subfertile client with past fertility problems. METHODS In 2011, we interviewed two couples and seven women who conceived through fertility treatment and received primary midwifery care at some point during their pregnancies. This explorative, qualitative study was based on the interpretivist/constructivist paradigm. RESULTS Although the participants are not representative of all subfertile clients, the findings of our qualitative study highlight the needs of women and their partners who have become pregnant through fertility treatment including help from the primary care midwife in understanding the likely course of their pregnancy, more psychosocial support and acknowledgement of the fertility treatment history, and more consultations and frequent ultrasound scans than usual to confirm pregnancy. CONCLUSIONS Our study points out that the women who have become pregnant through fertility treatment and their partners communicate seemingly paradoxical prenatal care needs. It can help maternity care providers to optimally meet the care needs of subfertile clients and empower them during their transition from subfertility to parenthood.
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Affiliation(s)
- J. Catja Warmelink
- Midwifery Academy Amsterdam-Groningen, Dirk Huizingastraat,
Groningen,
The Netherlands,
,Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center,
Amsterdam,
The Netherlands,
,Address for correspondence: J. C. Warmelink,
Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center,
Amsterdam,
The Netherlands. Tel: +31 0 50 3618886. E-mail:
| | - Wietske Adema
- Midwifery Academy Amsterdam-Groningen, Dirk Huizingastraat,
Groningen,
The Netherlands,
,Midwifery practice Leeuwarden,
The Netherlands
| | - Annelies Pranger
- Midwifery Academy Amsterdam-Groningen, Dirk Huizingastraat,
Groningen,
The Netherlands,
,Midwifery practice Dokkum and Drachten,
The Netherlands
| | - T. Paul de Cock
- Midwifery Academy Amsterdam-Groningen, Dirk Huizingastraat,
Groningen,
The Netherlands,
,Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center,
Amsterdam,
The Netherlands
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