Psychological distress in pregnancy and postpartum

Experiences of attending prenatal ultrasounds during the COVID-19 pandemic in Australia: A cross-sectional survey

BACKGROUND

Prenatal ultrasounds form an important part of routine maternity care in Australia and indeed internationally. The COVID-19 pandemic necessitated rapid changes in society and healthcare to curb transmission, with evidence demonstrating detrimental impacts on childbearing women associated with these restrictions. However, experiences with pandemic restrictions for prenatal ultrasounds in relation to distress, patient expectations, and satisfaction are largely unknown. This study aimed to explore the experiences of pregnant women attending prenatal ultrasound during the pandemic in Australia.

METHODS

A cross-sectional online survey of people in Australia who had undergone at least one prenatal ultrasound during the period of maternity care restrictions was performed. The survey included validated tools for assessing post-traumatic stress, satisfaction, and expectations with maternity care.

RESULTS

A total of 1280 responses were obtained. Almost 37% of respondents returned a PCL-C score consistent with probable post-traumatic stress disorder. Unexpected ultrasound findings or a high PCL-C score were more likely to have higher expectations and lower levels of satisfaction with their maternity care experience. Having an ultrasound for pregnancy loss, fetal abnormality, and/or a prior post-traumatic stress disorder diagnosis were the strongest factors correlating with a high PCL-C score.

DISCUSSION

The prevalence of post-traumatic stress symptoms in the study population is concerning and elucidates the distress experienced in association with prenatal ultrasounds during pandemic restrictions in Australia. Maternity services should acknowledge the high levels of service consumers with post-trauma symptoms and consider trauma-responsive maternity care adaptations in response to adverse perinatal outcomes for those afflicted with post-trauma and distress-related symptoms.

Prenatal psychological distress and 11β-HSD2 gene expression in human placentas: Systematic review and meta-analysis

BACKGROUND

The placenta acts as a buffer to regulate the degree of fetal exposure to maternal cortisol through the 11-Beta Hydroxysteroid Dehydrogenase isoenzyme type 2 (11-β HSD2) enzyme. We conducted a systematic review and meta-analysis to assess the effect of prenatal psychological distress (PPD) on placental 11-β HSD2 gene expression and explore the related mechanistic pathways involved in fetal neurodevelopment.

METHODS

We searched PubMed, Embase, Scopus, APA PsycInfo®, and ProQuest Dissertations for observational studies assessing the association between PPD and 11-β HSD2 expression in human placentas. Adjusted regression coefficients (β) and corresponding 95% confidence intervals (CIs) were pooled based on three contextual PPD exposure groups: prenatal depression, anxiety symptoms, and perceived stress.

RESULTS

Of 3159 retrieved records, sixteen longitudinal studies involving 1869 participants across seven countries were included. Overall, exposure to PPD disorders showed weak negative associations with the placental 11-β HSD2 gene expression as follows: prenatal depression (β -0.01, 95% CI 0.05-0.02, I2=0%), anxiety symptoms (β -0.02, 95% CI 0.06-0.01, I2=0%), and perceived stress (β -0.01 95% CI 0.06-0.04, I2=62.8%). Third-trimester PPD exposure was more frequently associated with lower placental 11-β HSD2 levels. PPD and placental 11-β HSD2 were associated with changes in cortisol reactivity and the development of adverse health outcomes in mothers and children. Female-offspring were more vulnerable to PPD exposures.

CONCLUSION

The study presents evidence of a modest role of prenatal psychological distress in regulating placental 11-β HSD2 gene expression. Future prospective cohorts utilizing larger sample sizes or advanced statistical methods to enhance the detection of small effect sizes should be planned. Additionally, controlling for key predictors such as the mother's ethnicity, trimester of PPD exposure, mode of delivery, and infant sex is crucial for valid exploration of PPD effects on fetal programming.

Systematic Review of Barriers to and Facilitators of Screening for Postpartum Depression at Well-Child Visits in the United States

OBJECTIVE

To identify and evaluate barriers to and facilitators of screening for postpartum depression (PPD) during well-child visits in the United States. Additionally, to describe prior work on PPD screening tool evaluation and outcomes from PPD screenings conducted within the well-child setting.

DATA SOURCES

A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Five databases (Pub Med, PsycINFO, Web of Science, CINAHL, and Cochrane Library) were searched.

STUDY SELECTION

Randomized controlled trials, case studies, cross-sectional studies, case-control studies, cohort studies, qualitative studies, and quasi-experimental studies conducted in the United States were included. The Standard Quality Assessment Criteria Tool (QualSyst) was used to assess the methodologic quality of each included study.

DATA EXTRACTION

Sample, setting, methods, screening tools used, location of study setting, intervention, and salient findings were extracted and summarized for further analysis and synthesis.

DATA SYNTHESIS

Quantitative studies were rated on 14 aspects, and qualitative studies were rated on 10 aspects, per QualSyst. Studies received a score of 2, 1, 0, or not applicable based on scoring criteria, with higher scores indicating greater methodologic quality.

CONCLUSION

We found that barriers to PPD screening included concerns regarding time for screening, adequate training, and limited ability for referral. Facilitators of PPD screening included electronic prompts for providers, as well as tool availability and familiarity. Our results indicate that education and training about PPD screening in the pediatric setting are important next steps in addressing the rising concern of PPD in the United States.

Psychological Health and Ischemic Heart Disease in Women: A Review of Current Evidence and Clinical Considerations across the Healthspan

PURPOSE OF REVIEW

Psychological health encompasses a constellation of negative and positive factors-i.e., psychosocial stress, depression, anxiety, trauma, loneliness and social isolation, anger and hostility, optimism, and a sense of purpose. This narrative review presents current evidence at the intersection of psychological health, risk of ischemic heart disease (IHD), and IHD-related outcomes, with an emphasis on associations in women.

RECENT FINDINGS

For women, relations between psychological health and IHD reflect important sex and gender differences in biological and psychosocial factors. Although efforts devoted to understanding psychological health and IHD risk have varied by psychological factor-scientific evidence is strongest for psychosocial stress and depression, while anxiety, trauma, and positive psychological factors warrant more investigation-less optimal psychological health is consistently associated with an earlier and greater risk of IHD morbidity and mortality in women. Still, many past prospective studies of psychological factors and IHD risk had a limited representation of women, did not include analyses by sex, or failed to account for other influential, sex-specific factors. Thus, there are multiple pathways for further, rigorous investigation into psychological health-IHD associations, mechanisms, and empirically supported psychological interventions to mitigate IHD risk among women. Given the robust evidence linking psychological health with women's risk for IHD, implementing routine, brief, psychological screening is recommended. Significant life events, developmental milestones specific to women, and IHD diagnoses or events could cue further psychological assessment and referral, efforts which will mutually strengthen the evidence for integrated psychological and IHD care and delivery of such care to this vulnerable group.

The role of stress in perinatal depression and anxiety - A systematic review

Perinatal depression (PND) and anxiety affect around 20% of women, but available pharmacotherapy is not sufficiently effective in 20-60% of them, indicating a need for better understanding of these diseases. Since stress is a significant risk factor for PND, the aim was to examine the role of biological, environmental and psychological stress in PND and anxiety through a systematic literature search. Overall 210 studies were included, among which numerous rodent studies showed that perinatal stress induced depressive-like and anxious behavior, which was associated with HPA-axis alterations and morphological brain changes. Human studies indicated that the relationship between cortisol and perinatal depression/anxiety was not as clear and with many contradictions, although social and psychological stress were clearly positively associated with PND. Finally, oxytocin, synthetic neuroactive steroid and n-3 PUFA diet have been identified as potentially beneficial in the therapy of PND and anxiety, worth to be investigated in the future.

A Preliminary Investigation of Prenatal Anxiety Sensitivity and Postpartum Distress

INTRODUCTION

Distress during pregnancy and postpartum is common and contributes to poor infant and maternal outcomes, such as developmental delays and mental health disorders, respectively. Anxiety sensitivity, or fear of the symptoms of anxiety (eg, palpitations, confusion), is a risk factor known to increase distress across psychological and health-related conditions. Given the physiologic and emotional changes that occur during the perinatal period, anxiety sensitivity may be a salient risk factor for maternal distress. In this pilot study, we aimed to understand the unique role of prenatal anxiety sensitivity in postpartum psychological and parenting distress.

METHODS

Twenty-eight pregnant women (mean age, 30.86 years) were recruited from the community in a Southeastern metropolitan area of the United States. Participants completed self-report measures during their third trimester of pregnancy and again within 10 weeks postpartum. The Depression Anxiety and Stress Scales-21 and the Parenting Distress subscale of the Parenting Stress Index-4-Short Form were the primary postpartum outcome measures.

RESULTS

Prenatal anxiety sensitivity was elevated in this sample relative to convenience samples. Prenatal anxiety sensitivity uniquely contributed to postpartum psychological (b, 1.01; P < .001) and parenting distress (b, 0.62; P = .008), after accounting for age, gravidity, and gestation.

DISCUSSION

Albeit preliminary, results suggest prenatal anxiety sensitivity may be an important and malleable risk factor associated with several mental health concerns common in the perinatal period. Anxiety sensitivity may be targeted with brief interventions to prevent or reduce postpartum distress. Reducing prenatal anxiety sensitivity has the potential prevent the onset or worsening of psychological disorders among women and, in turn, may improve infant and child outcomes. Future studies should replicate these findings in a larger sample.

An Overview for the General Psychiatrist Evaluating Patients With Obstetric and Neonatal Complications and Perinatal Loss

When neonatal and obstetrical complications occur, the identification and management of mood and anxiety disorders become complex with an ever-expanding array of psychiatric needs that include the management of grief- and trauma-related disorders. With high rates of maternal morbidity and mortality in the United States and laws in many states restricting reproductive health access, psychiatrists must be proficient in managing psychiatric sequelae in this context. High-risk groups for peripartum mood and anxiety disorders, posttraumatic stress disorder, and complicated grief include those with neonatal intensive care unit (NICU) stays and those who have experienced infertility and recurrent pregnancy loss. Groups who have been historically marginalized by the medical system (e.g., Black, Indigenous, people of color) and those from LGBTQ+ communities are at similarly high risk, and more interventions are needed to support these groups. Strategies emphasizing trauma-informed care, psychotherapeutic approaches, and using patient-centered language are recommended.

Identifying effective factors to alleviate postnatal distress and coronavirus anxiety in mothers of hospitalized preterm neonates

BACKGROUND

Given the critical importance of mental health in mothers of preterm neonates during the postpartum period for Population Youth Programs, our research aims to ascertain the correlation between postnatal distress and corona-induced anxiety in women who have hospitalized preterm neonates.

METHODS

This descriptive-analytical study was conducted with a sample of 275 mothers of preterm neonates, were hospitalized in Gorgan city in 2020. Data collection was facilitated through the Corona Anxiety (CA) and Postnatal Distress Measured Scale (PDM). For data analysis, Spearman's correlation and univariate and multiple linear regression were employed.

RESULTS

The average age of the participating mothers was 28.61 ± 6.173 years, and the average gestational age of the neonates was 32.8 ± 2.89 weeks. The study found a significant, positive correlation between CA and PDM. Controlling for other variables through multiple regression analysis, the factors that significantly influenced PDM were employment status (β = 3.88, p < 0.01), education level (β = 1.96, p = 0.032), and gestational age (β=-0.60, p < 0.001). Furthermore, number of living children (β=-4.77, p = 0.01), education (β=-2.37, p = 0.01), and gestational age (β=-0.91, p < 0.001) were the factors that were significantly associated with CA scores.

CONCLUSIONS

The correlation between CA and PDM suggests that preterm neonate's mothers experienced increased anxiety during the pandemic. Considering the factors influencing these anxieties, targeted programs should be developed to enhance the mental health of these mothers in future pandemics. The finding that women with more children experienced less CA could serve as evidence of the positive impact of having children on the mental health of women with premature infants during a pandemic.

Phenotypic Environmental Sensitivity and Mental Health During Pregnancy and Post Partum: Protocol for the Experiences of Pregnancy Longitudinal Cohort Study

BACKGROUND

Mental health problems during pregnancy and post partum are common and associated with negative short- and long-term impacts on pregnant individuals, obstetric outcomes, and child socioemotional development. Socio-environmental factors are important predictors of perinatal mental health, but the effects of the environment on mental health are heterogeneous. The differential susceptibility theory and the environmental sensitivity framework suggest that individuals differ in their degree of sensitivity to positive and negative environments, which can be captured by individual phenotypes such as temperament and personality. While there is strong evidence for these models in childhood, few studies examined them in adults, and they were not examined in pregnancy.

OBJECTIVE

The primary objective of the Experiences of Pregnancy study is to explore whether childhood and current environments are associated with mental health and well-being in pregnancy and whether these effects depend on individual sensitivity phenotypes (personality). This study also aims to gather important psychosocial and health data for potential secondary data analyses and integrative data analyses.

METHODS

We will conduct a longitudinal cohort study. The study was not registered elsewhere, other than this protocol. Participants will be recruited through social media advertisements linking to the study website, followed by an eligibility call on Zoom (Zoom Video Communications). Participants must be aged 18 years or older, currently residing in the United States as citizens or permanent residents, and currently planning to continue the pregnancy. A minimum of 512 participants will be recruited based on power analyses for the main objectives. Since the data will also be a resource for secondary analyses, up to 1000 participants will be recruited based on the available budget. Participants will be in their first trimester of pregnancy, and they will be followed at each trimester and once post partum. Data will be obtained through self-reported questionnaires assessing demographic factors; pregnancy-related factors; delivery, labor, and birth outcomes; early infant feeding; individual personality factors; childhood and current environments; mental health and well-being; attachment; and infant temperament. A series of measures were taken to safeguard the study from web robots and fraudulent participants, as well as to reduce legal and social risks for participants following Dobbs v. Jackson.

RESULTS

The study received ethics approval in April 2023 from the University of Oklahoma-Norman Campus Institutional Review Board. Recruitment occurred from May to August 2023, with 3 follow-ups occurring over 10 months.

CONCLUSIONS

The Experiences of Pregnancy study will extend theories of environmental sensitivity, mainly applied in children to the perinatal period. This will help better understand individual sensitivity factors associated with risk, resilience, plasticity, and receptivity to negative and positive environmental influences during pregnancy for pregnant individuals.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/49243.

Depression, anxiety, and stress in pregnant Black people: A case for screening and evidence-based intervention

BACKGROUND

Guidelines call for pregnant people to be screened for depression and anxiety. Screening may be particularly important for pregnant Black individuals who are reported to be more likely than non-Hispanic White pregnant people to experience prenatal stress, anxiety, and depressive symptoms. The purpose of this study was to determine if depression, anxiety, and stress co-occur in pregnant Black people and to identify which demographic factors are related to these mental health concerns.

METHODS

A subset analysis of an ongoing randomized controlled trial examined the risk of coexisting mental health conditions in pregnant Black people who screened eligible to participate (that is, they had high levels of depression, anxiety, and/or stress) in two urban clinics using a descriptive correlational design.

RESULTS

Of the 452 pregnant Black people who were screened for eligibility, 194 (42.9%) had elevated scores on depression, anxiety, and/or stress measures and were enrolled in the larger study. The average scores of the 194 enrolled participants were anxiety, mean (M) = 9.16 (standard deviation [SD] = 4.30); depression, M = 12.80 (SD = 4.27); and stress, M = 21.79 (SD = 4.76). More than one-third (n = 70, 36.1%) experienced two symptoms and 64 (33.0%) reported all three symptoms.

CONCLUSION

Pregnant Black individuals experience high levels of comorbid mental health distress including depression, anxiety, and stress. The findings indicate that treatment for mental health concerns needs to be broad-based and effective for all three conditions. Prenatal interventions should aim to address mental health distress through screening and treatment of depression, anxiety, and stress, especially for pregnant Black individuals. This study furthers understanding of the prevalence of prenatal mental health conditions in pregnant Black people.

A systematic review of clinical psychological guidance for perinatal mental health

BACKGROUND

Guidelines on psychological and/or psychosocial assessment and intervention in the perinatal period can provide beneficial practice guidance for healthcare professions to reduce maternal distress and potential mortality. As little is known about the similarities in recommendations across guidelines, which could impact the quality of therapeutic intervention women receive, this systematic review was conducted to draw out the consistent guidance for perinatal psychological and/or psychosocial therapeutic input.

METHOD

Eight literature and two guideline databases were searched alongside guideline development institutions, and organisations of maternity or perinatal mental health care. All relevant guidance was searched for and extracted before guideline quality was assessed using the AGREE-II instrument. Included guidelines had a primary or secondary focus on psychological assessment and therapeutic intervention for perinatal mental health difficulties. Using a narrative synthesis approach, recommendation consistencies and inconsistencies were outlined.

RESULTS

From the 92 records screened, seven guidelines met the inclusion criteria. Only two guidelines were rated high (> 80%) across all assessed domains, with the other guidelines scoring between poor and excellent across domains. Highest rated domains across all seven guidelines were clarity of presentation (75%) and scope and purpose (70%). Recommendations for structured psychological assessment and intervention were most commonly reported in the guidelines; however, the level of detail and depth of information varied across guidelines. Whilst assessment and intervention recommendations for mother-infant dyad and partners were considered, research into working therapeutically with these client groups in perinatal mental health services is only just emerging. Hence, guideline recommendations for working with the mother-infant dyad and partners were based on consensus of expert opinion.

CONCLUSION

Perinatal mental health guidelines were consistent in scope but showed considerable variability in quality and depth of recommendations, which could have implications for standards of clinical practice. However, there is still a need to improve the evidence underpinning recommendations in perinatal mental health guidelines to advance the implementation of psychological and/or psychosocial interventions. High quality interventions in the perinatal period could improve outcomes for women and their families.

Postpartum stress in the first 6 months after delivery: a longitudinal study in Nantong, China

OBJECTIVES

The objective is to to explore the longitudinal change trajectories of postpartum stress and its related factors.

DESIGN

A longitudinal study with follow-ups from 42 days to 6 months after delivery.

SETTINGS AND PARTICIPANTS

A total of 406 postpartum women were recruited at baseline (42 days after delivery) from 6 hospitals in Nantong, Jiangsu Province, China, and followed up at 3 and 6 months. After the follow-ups, 358 postpartum women were retained for further analysis.

METHODS

Postpartum stress was evaluated using the Maternal Postpartum Stress Scale (MPSS) at baseline (42 days) and 3 and 6 months after delivery. MPSS has three dimensions, such as: personal needs and fatigue, infant nurturing and body changes and sexuality. Postpartum depression and anxiety were measured using the Edinburgh Postnatal Depression Scale and the short-form Depression, Anxiety and Stress Scale, respectively. The MPSS scores were normalised using a rank-based inverse normal transformation.

RESULTS

Postpartum stress decreased significantly after 3 months, and postpartum stress reduced further after 6 months. Additionally, the scores for all three dimensions reduced after 6 months, while infant nurturing reduced after both 3 and 6 months. Older age (β=0.028, p=0.049), higher education level (β=0.153, p=0.005) and higher body mass index (BMI) (β=0.027, p=0.008) of the postpartum women were significantly associated with higher postpartum stress levels in corresponding dimensions at 42 days. Older age was also associated with higher postpartum stress at 3 (β=0.030, p=0.033) and 6 months (β=0.050, p<0.001) in the dimension of personal needs and fatigue. Postpartum stress levels were significantly higher in women with depression or anxiety symptoms.

CONCLUSIONS

Postpartum stress continuously declined from 42 days to 6 months after delivery. Postpartum women with older age, higher education levels, higher BMI and anxiety or depression symptoms should be the target population for early intervention.

The effect of spousal support on distress experienced during pregnancy in COVID-19 pandemic: Sample of Türkiye

We conducted this study with 147 volunteer pregnant women to determine the effect of spousal support on the stress experienced during pregnancy during the COVID-19 pandemic period. We determined that the prenatal stress level of the pregnant women was low (15.34 ± 7.07), they were not at risk for distress, and the spousal support level was high (74.58 ± 8.78). We found that the rate of spousal support was 0.897 times higher for women who did not experience distress. Due to the stay-at-home rule during the pandemic, couples had to be together at home, which caused high spousal support, and we found that women's stress levels were lower.

Influence of maternal psychological distress during COVID-19 pandemic on placental morphometry and texture

The Coronavirus Disease 2019 (COVID-19) pandemic has been accompanied by increased prenatal maternal distress (PMD). PMD is associated with adverse pregnancy outcomes which may be mediated by the placenta. However, the potential impact of the pandemic on in vivo placental development remains unknown. To examine the impact of the pandemic and PMD on in vivo structural placental development using advanced magnetic resonance imaging (MRI), acquired anatomic images of the placenta from 63 pregnant women without known COVID-19 exposure during the pandemic and 165 pre-pandemic controls. Measures of placental morphometry and texture were extracted. PMD was determined from validated questionnaires. Generalized estimating equations were utilized to compare differences in PMD placental features between COVID-era and pre-pandemic cohorts. Maternal stress and depression scores were significantly higher in the pandemic cohort. Placental volume, thickness, gray level kurtosis, skewness and run length non-uniformity were increased in the pandemic cohort, while placental elongation, mean gray level and long run emphasis were decreased. PMD was a mediator of the association between pandemic status and placental features. Altered in vivo placental structure during the pandemic suggests an underappreciated link between disturbances in maternal environment and perturbed placental development. The long-term impact on offspring is currently under investigation.

The Level of Stress and Anxiety in Pregnant Women Depending on Social Support and Physical Activity

Social support and physical activity are mentioned among the numerous factors affecting the emotional state of pregnant women. Therefore, the aim of the study was to assess the level of perceived stress and anxiety in pregnant women depending on social support and their physical activity both before and during pregnancy and find the factors that affected the level of perceived stress.

METHODS

A total of 373 pregnant women were qualified for the study. The Perceived Stress Scale (PSS-10), the State-Trait Anxiety Inventory (STAI), and a self-administered questionnaire were used.

RESULTS

In the study group, a high level of stress and anxiety were noted. A comparative analysis showed that physically active women before pregnancy, women attending childbirth classes and remaining in a relationship, were characterized by a lower level of stress and anxiety compared to physically inactive women, women who did not participate in childbirth classes and were single. A multiple linear regression analysis showed that participation in childbirth classes, physical activity before pregnancy, the level of anxiety as a trait, and women's age had the most significant impact on the stress level of surveyed women.

CONCLUSIONS

Further research among pregnant women and women in the postpartum period is needed to confirm the benefits of physical activity and to identify as many factors as possible that may affect the emotional state of pregnant women.

Smooth Muscle Mineralocorticoid Receptor Promotes Hypertension After Preeclampsia

BACKGROUND

Preeclampsia is a syndrome of high blood pressure (BP) with end organ damage in late pregnancy that is associated with high circulating soluble VEGF receptor (sFlt1 [soluble Fms-like tyrosine kinase 1]). Women exposed to preeclampsia have a substantially increased risk of hypertension after pregnancy, but the mechanism remains unknown, leaving a missed interventional opportunity. After preeclampsia, women have enhanced sensitivity to hypertensive stress. Since smooth muscle cell mineralocorticoid receptors (SMC-MR) are activated by hypertensive stimuli, we hypothesized that high sFlt1 exposure in pregnancy induces a postpartum state of enhanced SMC-MR responsiveness.

METHODS

Postpartum BP response to high salt intake was studied in women with prior preeclampsia. MR transcriptional activity was assessed in vitro in sFlt1-treated SMC by reporter assays and PCR. Preeclampsia was modeled by transient sFlt1 expression in pregnant mice. Two months post-partum, mice were exposed to high salt and then to AngII (angiotensin II) and BP and vasoconstriction were measured.

RESULTS

Women exposed to preeclampsia had significantly enhanced salt sensitivity of BP verses those with a normotensive pregnancy. sFlt1 overexpression during pregnancy in mice induced elevated BP and glomerular endotheliosis, which resolved post-partum. The sFlt1 exposed post-partum mice had significantly increased BP response to 4% salt diet and to AngII infusion. In vitro, SMC-MR transcriptional activity in response to aldosterone or AngII was significantly increased after transient exposure to sFlt1 as was aldosterone-induced expression of AngII type 1 receptor. Post-partum, SMC-MR-KO mice were protected from the enhanced response to hypertensive stimuli after preeclampsia. Mechanistically, preeclampsia mice exposed to postpartum hypertensive stimuli develop enhanced aortic stiffness, microvascular myogenic tone, AngII constriction, and AngII type 1 receptor expression, all of which were prevented in SMC-MR-KO littermates.

CONCLUSIONS

These data support that sFlt1-induced vascular injury during preeclampsia produces a persistent state of enhanced sensitivity of SMC-MR to activation. This contributes to postpartum hypertension in response to common stresses and supports testing of MR antagonism to mitigate the increased cardiovascular risk in women after PE.

The Association Between Adverse and Positive Childhood Experiences and Marijuana Use During Lactation

Background: Adverse childhood experiences (ACEs) are associated with substance use later in life, including marijuana use. It is unknown whether these behaviors extend to lactating women. Our objective was to examine the association between childhood ACE and marijuana use in lactating individuals and determine whether positive childhood experiences (PCEs) modified this association. Methods: This study included 617 lactating individuals from the UC San Diego Human Milk Research Biorepository enrolled from 2015 to 2020. ACE and PCE histories were assessed by the Positive and Adverse Childhood Experiences questionnaire. Past 2-week marijuana use was self-reported at enrollment. Multivariable log-linear regressions were used to calculate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for ACE history and marijuana use, and to assess modification by PCE. Results: Marijuana use during lactation was higher among individuals who reported three or more ACEs (aRR = 2.58, 95% CI = 1.23-5.44), household dysfunction (aRR = 3.08, 95% CI = 1.17-8.10), sexual abuse (aRR = 2.25, 95% CI = 1.08-4.68), or physical abuse (aRR = 2.10, 95% CI = 1.02-4.13). There was no association between emotional abuse and marijuana use during lactation. There was no effect modification by PCEs. Conclusion: Higher ACE frequency, and specifically history of household dysfunction, physical abuse, or sexual abuse increased risk for marijuana use during lactation. Because of marijuana's potential adverse effects on the infant through human milk, postpartum ACE screening is warranted.

A cross-country study on the impact of governmental responses to the COVID-19 pandemic on perinatal mental health

This study aimed to analyse the role of governmental responses to the coronavirus disease 2019 (COVID-19) outbreak, measured by the Containment and Health Index (CHI), on symptoms of anxiety and depression during pregnancy and postpartum, while considering the countries' Inequality-adjusted Human Development Index (IHDI) and individual factors such as age, gravidity, and exposure to COVID-19. A cross-sectional study using baseline data from the Riseup-PPD-COVID-19 observational prospective international study (ClinicalTrials.gov: NCT04595123) was carried out between June and October 2020 in 12 countries (Albania, Brazil, Bulgaria, Chile, Cyprus, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom). Participants were 7645 pregnant women or mothers in the postpartum period-with an infant aged up to 6 months-who completed the Edinburgh Postnatal Depression Scale (EPDS) or the Generalised Anxiety Disorder Assessment (GAD-7) during pregnancy or the postpartum period. The overall prevalence of clinically significant depression symptoms (EPDS ≥ 13) was 30%, ranging from 20,5% in Cyprus to 44,3% in Brazil. The prevalence of clinically significant anxiety symptoms (GAD-7 ≥ 10) was 23,6% (ranging from 14,2% in Israel and Turkey to 39,5% in Brazil). Higher symptoms of anxiety or depression were observed in multigravida exposed to COVID-19 or living in countries with a higher number of deaths due to COVID-19. Furthermore, multigravida from countries with lower IHDI or CHI had higher symptoms of anxiety and depression. Perinatal mental health is context-dependent, with women from more disadvantaged countries at higher risk for poor mental health. Implementing more restrictive measures seems to be a protective factor for mental health, at least in the initial phase of the COVID-19.

Prenatal maternal stress during the COVID-19 pandemic and infant regulatory capacity at 3 months: A longitudinal study

The COVID-19 pandemic is a global traumatic experience for citizens, especially during sensitive time windows of heightened plasticity such as pregnancy and neonatal life. Pandemic-related stress experienced by mothers during pregnancy may act as an early risk factor for infants' regulatory capacity development by altering maternal psychosocial well-being (e.g., increased anxiety, reduced social support) and caregiving environment (e.g., greater parenting stress, impaired mother-infant bonding). The aim of the present longitudinal study was to assess the consequences of pandemic-related prenatal stress on infants' regulatory capacity. A sample of 163 mother-infant dyads was enrolled at eight maternity units in northern Italy. They provided complete data about prenatal stress, perceived social support, postnatal anxiety symptoms, parenting stress, mother-infant bonding, and infants' regulatory capacity at 3 months of age. Women who experienced emotional stress and received partial social support during pregnancy reported higher anxious symptoms. Moreover, maternal postnatal anxiety was indirectly linked to the infants' regulatory capacity at 3 months, mediated by parenting stress and mother-infant bonding. Dedicated preventive interventions should be delivered to mothers and should be focused on protecting the mother-infant dyad from the detrimental effects of pandemic-related stress during the COVID-19 healthcare emergency.

Social Support Levels, Mental Health Status and Related Factors in Postpartum Women During the Pandemic

The aim of this study was to determine the social support levels, mental health status and related factors of women in the postpartum period during the pandemic process. The data of the descriptive study were collected between 12 May and 27 June 2022. The study was conducted with 264 postpartum mothers who gave birth in a university hospital. Data were collected using Personal Information Form, General Health Questionnaire (GHQ-28) and Multidimensional Scale of Perceived Social Support (SDS). The total mean score of the mothers' GHQ-28 questionnaire was 5.70±5.44, and it was determined that 47.3% of them perceived their mental health as risky. There is a statistically significant difference in the GHQ-28 score distributions according to the mothers' age, education level, smoking, family and friend relations, desired pregnancy status, and previous psychological problems. In addition, when the factors related to SBL were examined, it was determined that the level of education, financial situation, friend relationship, and previous psychological problems were statistically significant. There is a positive and significant relationship between mothers' mental health status and social support levels. As a result, almost half of the mothers are at risk for their mental health. Some introductory characteristics of mothers affect their general health status and social support levels. According to these findings, it is recommended that more social support be given to mothers with risky mental health conditions by their families and health personnel.

Pre-partum HRV as a predictor of postpartum depression: The potential use of a smartphone application for physiological recordings

BACKGROUND

This study aimed to investigate the role of a time-domain Heart Rate Variability index (the root mean square of successive difference between NN intervals, rMSSD) as a predictor of the onset of postpartum depression. HRV has been related to an increased risk of depression in the general population. However, its role in pregnant women is not clear, and the potential use of smartphone applications to evaluate HRV in this population has not been investigated.

METHODS

In study 1, simultaneous electrocardiogram and smartphone photoplethysmography were collected. The rMSSD was determined from each recording to evaluate the accuracy of a smartphone application in the measurement of HRV. In study 2, 135 pregnant women provided rMSSD values measured through a smartphone application in the prepartum (second or third trimester) and filled in the Edinburgh Postnatal Depression Scale in the postpartum (one month after the childbirth).

RESULTS

Study 1 showed the excellent accuracy of the smartphone application in the measurement of rMSSD. Study 2 indicated that lower prepartum rMSSD predicted higher depressive symptoms in the postpartum (β = -0.217, p = 0.010) after controlling for prepartum depressive symptoms and other potential covariates.

LIMITATIONS

Artefacts (e.g., hand movements) might have corrupted the physiological signal registered.

CONCLUSION

This study showed that a reduced vagal tone, indexed by lower rMSSD, during pregnancy was a predictor of depressive symptoms one month after childbirth. The prepartum period may offer an important timeframe to implement preventive intervention on vagal modulation in order to prevent depressive symptoms in the postpartum.

A psycho-educational intervention programme for parents with SGA foetuses supported by an adaptive mHealth system: design, proof of concept and usability assessment

Background

Technology-based approaches during pregnancy can facilitate the self-reporting of emotional health issues and improve well-being. There is evidence to suggest that stress during pregnancy can affect the foetus and result in restricted growth and preterm birth. Although a number of mobile health (mHealth) approaches are designed to monitor pregnancy and provide information about a specific aspect, no proposal specifically addresses the interventions in parents at risk of having small-for-gestational-age (SGA) or premature babies. Very few studies, however, follow any design and usability guidelines which aim to ensure end-user satisfaction when using these systems.

Results

We have developed an interactive, adaptable mHealth system to support a psycho-educational intervention programme for parents with SGA foetuses. The relevant results include a metamodel to support the task of modelling current or new intervention programmes, an mHealth system model with runtime adaptation to changes in the programme, the design of a usable app (called VivEmbarazo) and an architectural design and prototype implementation. The developed mHealth system has also enabled us to conduct a proof of concept based on the use of the mHealth systems and this includes data analysis and assesses usability and acceptance.

Conclusions

The proof of concept confirms that parents are satisfied and that they are enthusiastic about the mHealth-supported intervention programme. It helps to technically validate the results obtained in the other stages relating to the development of the solution. The data analysis resulting from the proof of concept confirms that the stress experienced by parents who followed the mHealth-supported intervention programme was significantly lower than among those who did not follow it. This implies an improvement in the emotional health not only of the parents but also of their child. In fact, the babies of couples who followed the mHealth-supported programme weigh more than the babies of couples under traditional care. In terms of user acceptance and usability, the analysis confirms that mothers place greater value on the app design, usefulness and ease of use and are generally more satisfied than their partners. Although these results are promising in comparison with more traditional and other more recent technology-based approaches.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-022-02036-9.

Maternal prenatal psychological distress and vitamin intake with children's neurocognitive development

BACKGROUND

Maternal prenatal psychological distress (PPD) is increasingly linked to sub-optimal child neurodevelopment. Daily intake of prenatal vitamin during pre-conception and early pregnancy may ameliorate the effects of PPD on cognition in the offspring.

METHODS

PPD was assessed in early (12-16 weeks) and late (28-32 weeks) gestation in the Ontario Birth Study. Prenatal vitamin supplement intake information was collected in early gestation. Child cognition at 4 years was assessed using the NIH Toolbox. Poisson regression was used to investigate associations between PPD and/or prenatal vitamin intake and child cognition.

RESULTS

Four hundred and eighteen mother-child dyads were assessed. Moderate-severe PPD experienced during early gestation was associated with reduced cognition (adjusted incidence rate ratio (IRR_adj) = 3.71, 95% confidence interval (CI): 1.57-8.77, P = 0.003). Daily intake of prenatal vitamins was not associated with cognition (IRR_adj = 1.34, 95% CI: 0.73-2.46, P = 0.34). Upon stratification, the experience of mild-severe PPD with daily intake of prenatal vitamins was associated with higher incident rates of suboptimal cognition compared to children of women with daily prenatal vitamin intake without any episode of PPD (IRR_adj = 2.88, 95% CI: 1.1-7.4).

CONCLUSIONS

Moderate-severe PPD in early pregnancy is associated with poor cognition in children and daily intake of prenatal vitamin did not ameliorate this association.

IMPACT

Our findings expand on existing literature by highlighting that exposure to prenatal psychological distress (PPD), in moderate-to-severe form, in the early stages of pregnancy, can have detrimental effects on the offspring's cognitive development at 4 years. Overall, prenatal vitamin intake did not ameliorate the effects of PPD. Early screening and treatment of prenatal maternal mental illness is crucial.

The effects of family function, relationship satisfaction, and dyadic adjustment on postpartum depression

PURPOSE

To determine the effect of family function, relationship satisfaction, and dyadic adjustment on postpartum depression DESIGN AND METHODS: This descriptive, cross-sectional study was conducted in 337 postpartum mothers.

FINDINGS

Fifty-five mothers scored above the depression scale cutoff point (>13). Emotional violence from husband, poor problem solving and communication, low relationship satisfaction, dyadic adjustment, and consensus were important risk factors for postpartum depression (p < .0.05).

PRACTICE IMPLICATIONS

Family function and partner relationships should be a key focus for midwives and nurses in the postpartum period. Providing psychological interventions aimed at improving relationship functioning can help protect mothers against postpartum depression.

Body image dissatisfaction and interoceptive sensibility significantly predict postpartum depressive symptoms

BACKGROUND

During pregnancy women experience rapid and unique changes in body weight, shape and size over a relatively short time period. While research focused on the role of external bodily modifications during pregnancy, research on internal bodily variations is missing.

METHODS

In a longitudinal study, we recruited healthy pregnant women and measured whether and how depressive symptoms, body image dissatisfaction and the subjective tendency to focus on one's own internal bodily sensations, i.e., interoceptive sensibility, changed during pregnancy and postpartum. Pregnant women filled online self-report questionnaires during pregnancy (i.e. second and third trimester) and after (i.e. six weeks) the delivery, including the Body Areas Satisfaction Scale, the Multidimensional Assessment of Interoceptive Awareness, and the Edinburgh Postnatal Depression Scale.

RESULTS

While depressive symptoms remained stable in the peripartum, body image dissatisfaction increased in the postpartum compared to the pregnancy period, and interoceptive sensibility increased over pregnancy. Findings showed that the increase of body dissatisfaction through the peripartum and the levels of interoceptive sensibility in the early phase of pregnancy predicted depressive symptoms in the postpartum.

LIMITATIONS

Interoception was evaluated as a subjective measure (i.e., interoceptive sensibility). Future studies may include objective measures of interoceptive accuracy and interoceptive awareness.

CONCLUSIONS

The current study supports the importance of body image dissatisfaction and interoceptive sensibility in the development of postpartum depressive symptoms. Future studies need to investigate if interventions aimed to increase interoceptive sensibility might be useful in preventing depressive symptoms and identify the mechanisms that can lead to these changes.

The influence of lifestyles to cope with stress over mental health in pregnant and postpartum women during the COVID-19 pandemic

The COVID-19 pandemic affected daily life routines and lifestyles of pregnant and postpartum women and increased their stress and risk of suffering from mental health problems. The aim of this study was to analyse which sociodemographic variables, COVID-19 exposure variables and lifestyles to cope with stress variables predicted anxiety, depression, and PTSD symptoms in pregnant and postpartum women during the COVID-19 pandemic. A cross-sectional design was performed with a sample of 3356 Spanish women participating in the Riseup-PPD-COVID-19 study. These participants completed an online survey composed of measures of anxiety (GAD-7), depression (EPDS), and PTSD related to COVID-19 (Checklist DSM-5), as well as demographics, exposure to COVID-19, and lifestyles to cope with stress. Regarding results, 47.2% showed depression and a third reported anxiety, whereas moderate scores were observed in PTSD symptoms. The most commonly used strategies to cope with stress in the COVID-19 pandemic were talking with friends and family and increasing time with social networks. Better results in mental health were associated with coping strategies such as talking with family and friends or participating in family activities, physical activity, sleeping well at night, eating healthier, and increasing personal care. Furthermore, poor results in mental health were observed in those participants who increased time with screens, ate fast food, reported substance use, and talked more frequently with health professionals. More symptoms were also observed in younger women, primiparous women, and those who reported more exposure to COVID-19. The results underline the need to strengthen the mental health of pregnant and postpartum women. Trial registration: ClinicalTrials.gov Identifier: NCT04595123.

Crisis and mental health of working women: risk factors and integrated care interventions based on organizational, individual, and institutional partnership

Purpose

Crises can weigh heavily on individuals' mental health. COVID-19 is a crisis that has shaken humanity, plunging it into a great wave of fear, ambiguity and uncertainty, due to its novelty and rapid spread, as well as lethality. Mental health disparities between women and men have widened as a result of this pandemic. Stress factors have multiplied, especially among working women, making them more psychologically vulnerable than they were before this pandemic and easy prey to psychological distress. This emphasized the importance of having integrated care interventions that take into consideration the organizational context, with gendered lenses. This paper discusses the relationship between COVID-19 and psychological distress among women in the workforce. It presents the main sources of stress and addresses integrated care interventions that can help to prevent psychological distress among women.

Design/methodology/approach

This paper is a viewpoint and critique of the recent literature.

Findings

Interventions based on a partnership between employers, employees, and government, including health and social services are needed to prevent mental health problems among women in the workplace that can result from crises. In this case, a gendered approach as well as an optimization of the use of new technologies should be favored.

Originality/value

There is little focus on the development of integrated care approaches to address psychological distress among working women in times of crisis and beyond. This paper helps to expand the scope of integrated care to work-related mental health research by exploring the impact of an unprecedented health crisis on a vulnerable group that suffers from disparities in mental health. It also provides insights into preventive interventions, built upon an integrated care approach, based on a tripartite partnership between working women, employing organizations, and governmental institutions, facilitated by the integration of new technologies. By doing this, the author aims to contribute to the prevention of mental health issues that can result from this crisis.

Factors Related to Psychological Distress in Multiparous Women in the First Trimester: A Cross-Sectional Study

BACKGROUND

The birth rate in Taiwan has declined rapidly; thus, encouraging women to give birth is an important issue in the country. Pregnant women may experience psychological distress, which may negatively impact the health of children and mothers. Prenatal psychological distress is more common in multiparous women than in primiparous women. In addition, compared with that in the second and third trimesters, psychological distress in the first trimester is relatively high. Understanding psychological distress and the associated factors for multiparous women in the first trimester is important to providing early interventions and preventing subsequent maternal and child health problems.

PURPOSE

This study was designed to examine the important predictive factors related to depression, anxiety, and stress among Taiwanese multiparous women in the first trimester.

METHODS

A cross-sectional design was used. In all, 216 multiparous women at 16 weeks of pregnancy were recruited from three hospitals in Taiwan. Self-reported questionnaires were used to gather data on demographic characteristics, the parenting stress of motherhood, spousal support, and psychological distress. A multiple logistic regression analysis was conducted to examine the factors associated with psychological distress.

RESULTS

The prevalence of depression, anxiety, and stress in multiparous women was found to be 31.9%, 42.6%, and 11.1%, respectively. The multiple logistic regression analysis indicated that the stress related to parent-child interaction was a significant predictor of depression and anxiety, the stress related to child-rearing was a significant predictor of anxiety, and low spousal instrumental support was a significant predictor of stress. The model respectively explained 30%, 27%, and 23% of the variance in depression, anxiety, and stress.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Reducing the stress related to parent-child interaction and child-rearing and encouraging spousal instrumental support should be considered during prenatal care when designing interventions to reduce the psychological distress of multiparous women in their first trimester.

Moderating Effect of Changes in Perceived Social Support during Pregnancy on the Emotional Health of Mothers and Fathers and on Baby’s Anthropometric Parameters at Birth

(1) Background: this study is based on a model of how changes in protective factors may affect the emotional health of mothers and fathers and thus influence the development of the baby. Our research goal is to determine whether variations in perceived social support moderate levels of stress and depression during pregnancy and/or the effect of parents’ emotional health on the baby’s anthropometric parameters. (2) Methods: to achieve these aims, a longitudinal study was made of 132 couples and babies, who were evaluated at weeks 12 and 32 of gestation and at birth. Separate analyses were performed for the mothers and fathers, focused on the role of social support in moderating their levels of depression and stress during pregnancy, and the consequent impact on the baby. (3) Results: the results obtained show the moderating effects of changes in social support on maternal and paternal stress and depression. Reduced social support during pregnancy is associated with higher levels of stress and depression in both parents and with a high cephalisation index in their babies. (4) Conclusions: special attention should be paid to social support, which can have a strong impact on the evolution of emotional health during pregnancy and concomitantly on the development of the baby.

Postpartum women's attitudes to disclosure of adult-onset conditions in pregnancy

Background

Advanced prenatal genomic technologies can identify risks for adult‐onset (AO) conditions in the fetus, challenging the traditional purpose of prenatal testing. Professional guidelines commonly support disclosure of high‐penetrance AO actionable conditions, yet attitudes of women/parents to these findings and factors affecting their attitudes are understudied.

Methods

We explored 941 (77% response rate) postpartum women's attitudes towards receiving prenatal genetic information, and associations of sociodemographic, medical and psychological characteristics with their choices, focusing on AO conditions.

Results

Women largely support the disclosure of actionable AO findings (58.4%), in line with professional guidelines. A third of the women also supported the disclosure of non‐actionable AO conditions. Stronger religious observance (p < 0.001) and higher psychological distress (p = 0.024) were associated with decreased interest in receiving actionable AO conditions, whereas higher concern for fetal health yielded increased interest (p = 0.032). Attitudes towards disclosure were strongly associated with women's perceived benefit of such information for their own, partner's, and future child's health. Termination of pregnancy based on such information received very little support.

Conclusion

In‐light of the demonstrated understanding of nuanced genetic information and the observed diversity in attitudes, a culturally competent opt‐in/out policy could be considered. If full‐disclosure is practiced, support should be provided to those expressing higher levels of distress.

What is known

Advanced prenatal genomic technologies can identify risks for adult‐onset (AO) conditions.

Professional guidelines support disclosure of high‐penetrance AO actionable conditions in pregnancy, yet attitudes of women/parents towards receiving this information are understudied.

What this study adds

Investigating the attitudes of nearly 1000 postpartum women demonstrates that women largely support the disclosure of actionable AO findings in pregnancy.

Stronger religious observance and higher psychological distress predict decreased interest in receiving this information.

[Factors influencing pregnancy stress in pregnant women in Korea: a cross-sectional study]

Purpose

The purpose of this study was to investigate the association between maternal knowledge and social support on pregnancy stress among pregnant women in Korea.

Methods

The participants in this study were 148 pregnant women in Korea, recruited from online communities on pregnancy and/or childbirth, from June 2019 to April 2020. The collected data were analyzed using the independent t-test, one-way analysis of variance, Pearson correlation coefficient, and multiple regression.

Results

Participants were at average 18.25±8.28 weeks gestation, 56% were in the second trimester, 31% had one or more health issues in the current pregnancy (e.g., hyperemesis gravidarum), and 76% were first-time mothers. Participants had moderate levels of pregnancy stress (mean, 23.09±7.11 points out of 48) and maternal knowledge (mean, 14.42±4.67 points out of 21), whereas social support was somewhat high (mean 45.88±7.81 points out of 60). Pregnancy stress was weakly negatively correlated with social support (r=-.37, p<.001). Main source of pregnancy information (β=-.21, p=.011), marital satisfaction (β=-.18, p=.036), and social support (β=-.19, p=.038) were identified as significant factors affecting pregnancy stress, and these variables had an explanatory power of 22.7% for pregnancy stress.

Conclusion

Based on these findings, nurses should assess pregnancy-related stress during pregnancy and consider main source of pregnancy information and marital satisfaction when providing education or counseling. Moreover, strategies to reduce pregnancy stress through social support are needed to improve the quality of life for pregnant women.

Socioemotional development in infants of pregnant women during the COVID-19 pandemic: the role of prenatal and postnatal maternal distress

BACKGROUND

An upsurge in psychological distress was documented in pregnant women during the COVID-19 pandemic. We investigated with a longitudinal design whether prenatal and postnatal maternal distress during the COVID-19 pandemic was associated with lower infant socioemotional development.

METHODS

Pregnant women (N = 468, Mage = 30,00, 97.6% White) were recruited during the first COVID-19 mandatory lockdown in Quebec, Canada, from April 2nd to April 13th 2020 and were re-contacted at two months postpartum to complete self-reported measures of general (i.e. not specifically related to the COVID-19 pandemic) anxio-depressive symptoms and infant development. Structural equation modeling analyses were performed using maximum likelihood parameter estimation.

RESULTS

Higher maternal prenatal distress significantly contributed to poorer infant socioemotional development. A mediation model showed that postnatal distress significantly mediated the association between prenatal distress and infant socioemotional development, whereas the direct effect of prenatal distress was no longer significant. Prenatal and postnatal maternal distress accounted for 13.7% of the variance in infant socioemotional development.

CONCLUSION

Our results call for special means of clinical surveillance in mothers and for innovative (online) interventions aiming to support maternal mental health during pregnancy and after delivery.

Changes in the Sexual Behavior of Partners in Each Trimester of Pregnancy in Otwock in Polish Couples

The aim of this study was to improve knowledge regarding pregnant couples by assessing changes in their sexual behavior, the reasons for the frequency and forms of intercourse, and the self-sexuality of partners in each trimester of pregnancy. As a result, 100 couples were qualified to take part in the final study, with 100 men and 100 women examined at intervals equivalent to the trimesters of pregnancy. These women (n = 100) and men (n = 100) were partners. Each of the studied couples was assessed in the trimesters of pregnancy. A prospective examination was conducted based on the observation of the same people, which were heterosexual couples, throughout pregnancy. The data used in the study was obtained using Davies’ Sexual Satisfaction Scale (DSSS), as well as an original survey on the sexuality of people during pregnancy (SARSS). The survey allowed us to obtain sociodemographic (metrics) information along with information regarding the sexual activity, satisfaction, and sexual attraction of the partners. All questionnaire questions were answered in paper form. There was a statistically significant drop in sexual intercourse from the first trimester in the second and third trimesters. The frequency of masturbation increased in men and decreased in women. The most common cause of sexual abstinence during the pregnancy was cited as fear for the fetus by all genders. A statistical analysis indicated that the average overall scores of the DSSS for the examined women in the first trimester of pregnancy were statistically significantly higher than in the two subsequent trimesters (p < 0.05). Sexual satisfaction, measured through both DSSS and SARSS, was also strongly correlated with the level of satisfaction in the assessment of the partner relationship and with the sense of one’s own attractiveness (p < 0.05). Changes in sexual behavior and sexual problems are often exposed or worsened during a first pregnancy and can have negative impacts on a person and the future of relationships. Medical staff should be trained in the assessment of sexual difficulties in people during pregnancy, in order to conduct reliable education and increase the awareness of couples regarding sexual and reproductive health.

Perceived Stress Positively Relates to Insomnia Symptoms: The Moderation of Resilience in Chinese Pregnant Women During COVID-19

BACKGROUND

The government's COVID-19 pandemic response lockdown strategy had a negative psychological and physical impact on individuals, which necessitated special care to pregnant women's mental health. There has been no large-scale research on the underlying relationship between perceived stress and insomnia symptoms in pregnant Chinese women up to this point. During the COVID-19 pandemic, we wanted to see if there was an association between perceived stress and insomnia symptoms, as well as the moderating impact of resilience for Chinese pregnant women.

METHODS

This cross-sectional study examined 2115 pregnant women from central and western China using multi-stage sampling methodologies. A systematic questionnaire was used to collect information on sleep quality, perceived stress, and resilience using the Insomnia Severity Index, Perceptual Stress Scale, and Connor and Davidson Resilience Scale. To assess the moderating influence of resilience, hierarchical regressions were used.

RESULTS

During the COVID-19 pandemic, 18.53% of respondents (N = 2115) reported experiencing sleeplessness. In pregnant women, perceived stress was positively linked with insomnia symptoms (p < 0.001). Furthermore, resilience significantly attenuated the influence of perceived stress on insomnia symptoms in Chinese expectant mother (β_interaction = -0.0126, p < 0.001).

CONCLUSION

Pregnant women with strong resilience were less influenced by perceived stress than those with poor resilience. The findings of this study might give empirical proof that health care professionals should identify the relevance of reducing perceived stress in pregnant women with poor resilience and provide better treatment and support when necessary.

A Technology-Based Pregnancy Health and Wellness Intervention (Two Happy Hearts): Case Study

BACKGROUND

The physical and emotional well-being of women is critical for healthy pregnancy and birth outcomes. The Two Happy Hearts intervention is a personalized mind-body program coached by community health workers that includes monitoring and reflecting on personal health, as well as practicing stress management strategies such as mindful breathing and movement.

OBJECTIVE

The aims of this study are to (1) test the daily use of a wearable device to objectively measure physical and emotional well-being along with subjective assessments during pregnancy, and (2) explore the user's engagement with the Two Happy Hearts intervention prototype, as well as understand their experiences with various intervention components.

METHODS

A case study with a mixed design was used. We recruited a 29-year-old woman at 33 weeks of gestation with a singleton pregnancy. She had no medical complications or physical restrictions, and she was enrolled in the Medi-Cal public health insurance plan. The participant engaged in the Two Happy Hearts intervention prototype from her third trimester until delivery. The Oura smart ring was used to continuously monitor objective physical and emotional states, such as resting heart rate, resting heart rate variability, sleep, and physical activity. In addition, the participant self-reported her physical and emotional health using the Two Happy Hearts mobile app-based 24-hour recall surveys (sleep quality and level of physical activity) and ecological momentary assessment (positive and negative emotions), as well as the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and State-Trait Anxiety Inventory. Engagement with the Two Happy Hearts intervention was recorded via both the smart ring and phone app, and user experiences were collected via Research Electronic Data Capture satisfaction surveys. Objective data from the Oura ring and subjective data on physical and emotional health were described. Regression plots and Pearson correlations between the objective and subjective data were presented, and content analysis was performed for the qualitative data.

RESULTS

Decreased resting heart rate was significantly correlated with increased heart rate variability (r=-0.92, P<.001). We found significant associations between self-reported responses and Oura ring measures: (1) positive emotions and heart rate variability (r=0.54, P<.001), (2) sleep quality and sleep score (r=0.52, P<.001), and (3) physical activity and step count (r=0.77, P<.001). In addition, deep sleep appeared to increase as light and rapid eye movement sleep decreased. The psychological measures of stress, depression, and anxiety appeared to decrease from baseline to post intervention. Furthermore, the participant had a high completion rate of the components of the Two Happy Hearts intervention prototype and shared several positive experiences, such as an increased self-efficacy and a normal delivery.

CONCLUSIONS

The Two Happy Hearts intervention prototype shows promise for potential use by underserved pregnant women.

The effectiveness of psychological interventions for pregnant women with anxiety in the antenatal period: A systematic review

OBJECTIVE

Anxiety is a significant public health concern, that if untreated may lead to adverse outcomes for mother, baby and the family unit. The aim of this review was to determine the efficacy of psychological interventions for pregnant women with anxiety in the antenatal period. Although guidelines recommend psychological interventions for managing anxiety in the perinatal period, there is a lack of strong evidence on the most effective psychological intervention for use in the antenatal period. Effective non-pharmacological interventions are an important area that requires significant clinical attention.

DESIGN

A systematic review of quantitative and qualitative studies was conducted using Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Applied Social Sciences Index and Abstracts (ASSIA), Web of Science and PsychInfo. Quality appraisal was performed using The Joanna Briggs Institute (JBI) critical appraisal tool to assess methodological quality on all six included papers. All four RCT's were assessed separately using the Cochrane Risk of Bias Tool.

FINDINGS

Of the 7278 articles, six quantitative studies were included. The overall results of this review found that mindfulness based interventions are by far the most effective intervention for the treatment of anxiety in the antenatal period. These findings are not in line with current guidance on treatment of women with anxiety in the antenatal period and warrants immediate attention.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Healthcare professionals need to be aware of the potential benefits of mindfulness based interventions in practice. There is some evidence to support their use in the antenatal period, however, there remains insufficient evidence to confidently advocate for their use in practice. Follow-up research needs to be conducted on the efficacy of mindfulness based interventions on women with anxiety in the antenatal period using rigorous RCT's. Education and training of Midwives to help promote and use this intervention is recommended.

"Whatsapping" the continuity of postpartum care in Switzerland: A socio-anthropological study

BACKGROUND

Digital media such as Apps, Internet and social networks have become integral parts of the maternity experience for more than a decade. These media can support or undermine women's experiences as has been shown in digital sociology research. Using Immediate Messaging Applications to provide information and support to women during the perinatal period is an emerging practice.

AIM

This article analyses how health and social care professionals - with a focus on community midwives - and women communicate between postpartum home visits through Immediate Message Applications in Switzerland.

METHODS

A socio-anthropological study that relied on qualitative methods including semi-directed interviews with midwives and health and social care professionals (n = 30) and immigrant women (n = 20).

FINDINGS

Since the introduction of Immediate Messaging Applications, women and their carer converse more regularly between post-partum home visits. Women send questions, pictures and videos to them, often allowing swift responses to their concerns. Midwives encounter difficulties answering women's questions when they cannot be solved through quick communication (e.g. infant crying). To them, texting frequency forms a clinical clue to women's mental health. Not all women contact their carer through digital messages; immigrant women are less likely to know and use this service.

DISCUSSION AND CONCLUSION

Immediate Messaging Applications form a promising communication tool, complementary to home visits, and contribute to woman-centered care and continuity of care. As an emergent practice, it has not been framed by a guideline yet. Policy makers and practitioners should ensure that its use does not contribute to unequal access to care.

Identifying Patterns of Symptom Distress in Pregnant Women: A Pilot Study

During pregnancy, a woman's enlarged uterus and the developing fetus lead to symptom distress; in turn, physical and psychological aspects of symptom distress are often associated with adverse prenatal and birth outcomes. This study aimed to identify the trends in the trajectory of these symptoms. This longitudinal study recruited 95 pregnant women, with a mean age of 32 years, from the prenatal wards of two teaching hospitals in northern Taiwan. Symptom distress was measured by a 22-item scale related to pregnancy-induced symptoms. The follow-up measurements began during the first trimester and were taken every two to four weeks until childbirth. More than half of the pregnant women experienced symptom distress manifested in a pattern depicted to be "Decreased then Increased" (56.8%). Other noticeable patterns were "Continuously Increased" (28.4%), "Increased then Decreased" (10.5%) and "Continuously Decreased" (4.2%), respectively. It is worth noting that most pregnant women recorded a transit and increase in their symptom distress, revealed by their total scores, at the second trimester (mean 22.02 weeks) of pregnancy. The participants' major pregnancy-related distress symptoms were physical and included fatigue, frequent urination, lower back pain, and difficulty sleeping. The mean scores for individual symptoms ranged from 2.32 to 3.61 and were below the "moderately distressful" level. This study provides evidence that could be used to predict women's pregnancy-related symptom distress and help healthcare providers implement timely interventions to improve prenatal care.

Maternal Distress and Social Support Are Linked to Human Milk Immune Properties

Possible alterations of maternal immune function due to psychological stress may reflect immunoactive factor levels in breast milk. This study aimed to assess the association between maternal distress and breast milk levels of secretory IgA (SIgA), IgM, IgG, and lactoferrin (LF). We hypothesized that this association is moderated by maternal social support achieved from others during lactation. The study group included 103 lactating mothers and their healthy five-month-old infants. Maternal distress was determined based on the State Anxiety Inventory and the level of salivary cortisol. Social support was assessed using the Berlin Social Support Scales. Breast milk samples were collected to test for SIgA, IgM, IgG, and LF using the ELISA method. Milk immunoactive factors were regressed against maternal anxiety, social support, salivary cortisol, and infant gestational age using the general regression model. Maternal anxiety was negatively associated with milk levels of LF (β = -0.23, p = 0.028) and SIgA (β = -0.30, p = 0.004), while social support was positively associated with milk IgG (β = 0.25, p = 0.017). Neither anxiety nor social support were related to milk IgM. No association was found between the level of maternal salivary cortisol and immunoactive factors in milk. Our results suggest that maternal psychological wellbeing and social support may affect milk immune properties.

Contemplating Help-Seeking in Perinatal Psychological Distress-A Meta-Ethnography

Perinatal psychological distress (PPD) may cause delays in help-seeking in the perinatal period, which is crucial for families with small children. Help-seeking theories focus on rational processes of behavior wherein ‘help-seeking’ is viewed as a decision-making process, in which action is preceded by recognizing a problem. We identified the phase prior to actual help-seeking actions as a life situation and a phenomenon through which to gain a deeper understanding from women’s own perspectives. The aim of this study was to integrate and synthesize knowledge of women’s experiences of contemplating seeking help for PPD. We chose interpretative meta-ethnography by Noblit and Hare (1988) and implemented eMERGe guidelines in reporting. The search was performed systematically, and the 14 included studies were evaluated with Critical Appraisal Skills Programme checklist (CASP). We identified seven themes and a metaphor in a lines-of-argument synthesis, showing that contemplating help-seeking is a multidimensional phenomenon. We did not observe a straightforward and linear process (as previous research suggests) but instead a complex process of contemplating help-seeking. A clinical implication is that service providers should work with outreach and develop their tools to connect with mothers with PPD. Another suggestion is to improve training in mental health literacy prior to or during pregnancy.

Midwives' provision of health promotion in antenatal care: A qualitative explorative study

PROBLEM

Studies indicate that health promotion in antenatal care can be improved. Moreover, a schism seems to exist between health promotion and prevention in antenatal care.

BACKGROUND

Antenatal care to support and improve maternal health is a core midwifery activity in which prevention as well as HP and woman-centeredness are important.

AIM

To explore how Danish midwives experienced antenatal care and practiced health promotion.

METHODS

Midwives undertaking antenatal care were interviewed individually (n=8) and two focus groups (n=10) were created. Thematic analysis was performed inductively, and the theoretical models from Piper's health promotion practice Framework for midwives were used to analyse the midwives' health promotion approach.

FINDINGS

Two major themes were highlighted. Theme 1: 'The antenatal care context for health promotion' described factors contributing to quality in health promotion in antenatal care, such as communication and building relationships with the pregnant women. Theme 2: 'The health promotion approach in antenatal care' described both midwife-focused and woman-focused approaches to pregnant women's health. Barriers to high-quality antenatal care and a holistic health promotion approach were identified, such as shared-care issues, documentation demands and lack of time.

DISCUSSION

The midwives' experiences were discussed in the context of a health promotion approach. Why midwives practice using a midwife-centred approach has many explanations, but midwives need to learn and help each other understand how they can practice woman-focused care while simultaneously providing prophylactic, evidence-based care.

CONCLUSION

Midwives mainly had a midwife-focused approach. To further promote women's health, midwives need to focus on a woman-focused approach.

Feeling the Void: Lack of Support for Isolation and Sleep Difficulties in Pregnant Women during the COVID-19 Pandemic Revealed by Twitter Data Analysis

Pregnant women face many physical and psychological changes during their pregnancy. It is known that stress, caused by many factors and life events such as the COVID-19 pandemic, can negatively impact the health of mothers and offspring. It is the first time social media, such as Twitter, are available and commonly used during a global pandemic; this allows access to a rich set of data. The objective of this study was to characterize the content of an international sample of tweets related to pregnancy and mental health during the first wave of COVID-19, from March to June 2020. Tweets were collected using GetOldTweets3. Sentiment analysis was performed using the VADER sentiment analysis tool, and a thematic analysis was performed. In total, 192 tweets were analyzed: 51 were from individuals, 37 from companies, 56 from non-profit organizations, and 48 from health professionals/researchers. Findings showed discrepancies between individual and non-individual tweets. Women expressed anxiety, depressive symptoms, sleeping problems, and distress related to isolation. Alarmingly, there was a discrepancy between distress expressed by women with isolation and sleep difficulties compared to support offered by non-individuals. Concrete efforts should be made to acknowledge these issues on Twitter while maintaining the current support offered.