Influences of prior miscarriage and weight status on perinatal psychological well-being, exercise motivation and behavior

Effect of Core Stabilization Exercises on Pain, Functional Disability, and Quality of Life in Pregnant Women With Lumbar and Pelvic Girdle Pain: A Randomized Controlled Trial

OBJECTIVE

The purpose of this study was to assess the effect of adding core stability to usual care for pregnant women with lumbar and pelvic girdle (LPG) pain.

METHODS

This was a repeated-measures design randomized controlled trial with blinded outcome assessors. Thirty-five pregnant women with LPG pain were recruited from prenatal health care providers. They were allocated to 2 study groups to receive either usual prenatal care (control group, n = 17) or usual care with core stability exercises focusing on the pelvic floor muscles and deep abdominal muscles (exercise group, n = 18) for 10 weeks. The visual analog scale, score on the Oswestry Disability Index, and the World Health Organization's Quality of Life Brief Version (WHOQOL-BREF) were evaluated with analysis of variance at pre-intervention, post-intervention, at the end of pregnancy, and 6 weeks after childbirth.

RESULTS

There was a statistically significant interaction of group and time for all outcome measures except for the Social category (P = .18) in the WHOQOL-BREF questionnaire. The analysis of the group within time showed that mean scores in the exercise group were substantially improved at the post-intervention, end of pregnancy, and 6-week follow-up evaluation, except in the Environment category (end of pregnancy: P = .36; 6-week follow-up: P = .75) in the WHOQOL-BREF questionnaire.

CONCLUSION

The results of this study indicate that the addition of core stability exercises was more effective than the usual care alone in pain relief, improving disability, and quality of life of pregnant women with LPG pain.

Longitudinal Changes in Physical Activity during Pregnancy: National Institute of Child Health and Human Development Fetal Growth Studies

INTRODUCTION

Exercise in pregnancy is associated with many perinatal benefits, but patterns of home, work, and commuting activity are not well described. We investigated longitudinal activity in singleton and twin pregnancy by activity domain and maternal characteristics.

METHODS

In the National Institute of Child Health and Human Development Fetal Growth Studies cohorts, 2778 women with singleton and 169 women with twin gestations reported activity using the Pregnancy Physical Activity Questionnaire at up to six or seven study visits, respectively. Metabolic equivalent of task-hours per week (MET-h·wk -1 ) was calculated from reported activity. Baseline measurements (obtained between 10 and 13 wk) reflected past year activity. Linear mixed models estimated MET-h·wk -1 by domain (household/childcare, occupational, inactive, transportation, sports/exercise), self-reported race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, Asian/Pacific Islander), prepregnancy body mass index (<25, 25 to < 30, ≥30 kg·m -2 ), parity (0, ≥1), baseline activity (quartiles), and plurality (singleton, twin).

RESULTS

Household/caregiving activity made up the largest fraction of reported MET-h·wk -1 at baseline (42%), followed by occupational activity (28%). Median summed activity declined 47%, from 297 to 157 MET-h·wk -1 , between 10 and 40 wk, largely driven by changes in household/caregiving (44% decline), and occupational activity (63% decline). Sports/exercise activity declined 55% but constituted only 5% of reported MET-h·wk -1 at baseline. At baseline, non-Hispanic Black women reported significantly higher activity than non-Hispanic White or Hispanic women, but differences did not persist across pregnancy. Across gestation nulliparous women reported significantly lower activity than parous women. Women with singleton gestations reported significantly more activity than women with twins from weeks 26 to 38. Baseline activity level was strongly associated with later activity levels.

CONCLUSIONS

Measuring domains of activity beyond exercise, and collecting longitudinal measurements, is necessary to fully describe activity in diverse populations of pregnant women.

Cognitive Factors of Weight Management During Pregnancy Among Chinese Women: A Study Applying Protective Motivation Theory

PURPOSE

This study aimed to explore the psychological cognitive factors of weight management during pregnancy based on protective motivation theory (PMT).

DESIGN

Cross-sectional study.

SETTING

Participants were recruited at the Maternal and Child Health Hospital of Changzhou City, Jiangsu Province, China.

SAMPLE

A sample of 533 pregnant women was enrolled in the study.

MEASURES

Measures was a self-design questionnaire, comprising of demographics, cognition of weight management during pregnancy, and weight management behavior during pregnancy.

ANALYSIS

Structural equation modeling was used to examine the weight management's cognitive factors, path relationships, and the influence of maternal characteristics.

RESULTS

Self-efficacy cognition could promote gestational weight management behavior (b = .22, P < .001), but response cost cognition hindered gestational weight management (b = -.21, P < .001). Parity moderated pregnant women's self-efficacy cognition (diff b = .24, P < .01), where the self-efficacy of nullipara promoted weight management behaviors, but the self-efficacy of multipara had no significant effect. Also, the response cost factors stably existed in primipara and multipara groups, with multipara, being positively affected by response efficacy (b = .15, P < .05).

CONCLUSION

Findings highlight the need for psychological and cognitive interventions. Intervention strategies that focus on enabling women to correctly understand response cost and make an active response, improve self-efficacy cognition especially among primipara, and strengthening multipara's response efficacy among pregnant are required.

Experience of Late Miscarriage and Practical Implications for Post-Natal Health Care: Qualitative Study

Miscarriage is the most common reason for pregnancy loss, affecting around one in four pregnancies. It is classified as a traumatic event, associated with an increased risk for depression, anxiety, post-traumatic stress, alcohol dependence, somatic symptoms, sexual dysfunction, suicide, and complicated grief. This study aimed to analyse experiences of late miscarriage and to describe practical implications for post-natal health care based on characteristics of pregnancy loss revealed in a qualitative study. Seven women who had late miscarriages participated in in-depth biographical interviews. A phenomenological thematic analysis was applied. Experiential characteristics of late miscarriage were described by four themes and 13 subthemes: the initial splitting state (Dissociation, An Opened Void, An impaired Symbiosis, and The Body is Still Pregnant while the Psyche is Mourning); Betrayal of the body (Symbolic Experience of Internalised Death, Shocking Materiality of the Ongoing Miscarriage, Lost control of the Body, and Confusing Body Signals); Disconnecting (Depersonalising Medical Environment, Guilt Falsifies perception, and Retreat as a means of Self-Preservation); and Reconnecting (Collecting Shatters and Reinterpretation of Maternal Identity). Based on the results of the experiential analysis, another four themes represent practical recommendations for post-natal health care: Informing, Opportunity for Goodbye, Attention to Emotional Wellbeing, and Respectful Hospital Environment.

Motherhood in the Time of Coronavirus: The Impact of the Pandemic Emergency on Expectant and Postpartum Women's Psychological Well-Being

The birth of a child is a critical and potentially stressful experience for women, entailing several changes both at the individual and interpersonal level. This event can lead to different forms of distress, ranging in intensity and duration. Many studies highlighted medical, psychological, and social variables as risk factors potentially influencing the onset or aggravation of perinatal maternal conditions. The current pandemic emergency and the restrictive measures adopted by local governments to prevent the spread of the coronavirus infection may negatively affect mothers-to-be and new mothers potentially increasing the likelihood of anxiety, depressive or post-traumatic symptoms to develop. Moreover, the forced quarantine combined with the limited access to professional or family support may increase feelings of fatigue and isolation. The present study aims to investigate women's psychological well-being during pregnancy and in the first months after childbirth, integrating the evaluation of some traditionally studied variables with the specificities of the current situation. 575 Italian women have been administered an online self-report questionnaire assessing the presence of anxiety disorders, depressive and post-traumatic symptoms as well as the expectations toward childbirth (for mothers-to-be) or the subjective experience of childbirth (for postpartum women). Findings revealed a higher percentage of women than that reported in the literature scored above the clinical cut-off both during pregnancy and postpartum on a series of measures of psychological well-being, thus demonstrating that this period was perceived as particularly challenging and stressful and had significant impact on the women's well-being. Moreover, some socio-demographic, medical, and pandemic-related variables, especially the lack of presence and support from one's partner during labor and delivery as well as in the first days postpartum was found to predict women's mental health. These findings suggest the need for developing specific interventions targeted at women who cannot benefit from the support of their partners or family.