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Donofry SD, Jouppi RJ, Call CC, Kolko Conlon RP, Levine MD. Improvements in Maternal Cardiovascular Health Over the Perinatal Period Longitudinally Predict Lower Postpartum Psychological Distress Among Individuals Who Began Their Pregnancies With Overweight or Obesity. J Am Heart Assoc 2024; 13:e034153. [PMID: 38874183 PMCID: PMC11255758 DOI: 10.1161/jaha.123.034153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/15/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Adverse cardiovascular events during pregnancy (eg, preeclampsia) occur at higher rates among individuals with overweight or obesity (body mass index ≥25 kg/m2) and have been associated with postpartum depression. The present study examined whether changes in cardiovascular health (CVH) during the perinatal period, as defined by the American Heart Association's Life's Essential 8 framework, predicted postpartum psychological functioning among individuals with prepregnancy body mass index ≥25 kg/m2. METHODS AND RESULTS Pregnant individuals (N = 226; mean ± SD age = 28.43 ± 5.4 years; mean body mass index = 34.17 ± 7.15 kg/m2) were recruited at 12 to 20 weeks of gestation (mean, 15.64 ± 2.45 weeks) for a longitudinal study of health and well-being. Participants completed ratings of depression and perceived stress and reported on CVH behaviors (dietary intake, physical activity, nicotine exposure, and sleep) at baseline and at 6 months postpartum. Body mass index and CVH behaviors were used to calculate a composite CVH score at both time points. Linear regression analyses were performed to examine whether change in CVH related to postpartum symptom scores. Because sleep was measured in only a subset of participants (n = 114), analyses were conducted with and without sleep. Improved CVH was associated with lower postpartum depression (β = -0.18, P<0.01) and perceived stress (β = -0.13, P=0.02) scores. However, when including sleep, these relationships were no longer significant (all P>0.4). CONCLUSIONS Improvements in CVH from early pregnancy to 6 months postpartum were associated with lower postpartum depressive symptoms and perceived stress but not when including sleep in the CVH metric, potentially due to the large reduction in sample size. These data suggest that intervening during pregnancy to promote CVH may improve postpartum psychological functioning among high-risk individuals.
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Affiliation(s)
- Shannon D. Donofry
- RANDPittsburghPA
- Department of PsychologyUniversity of PittsburghPittsburghPA
| | - Riley J. Jouppi
- Department of PsychologyUniversity of PittsburghPittsburghPA
| | - Christine C. Call
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPA
| | | | - Michele D. Levine
- Department of PsychologyUniversity of PittsburghPittsburghPA
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPA
- Department of Obstetrics, Gynecology, and Reproductive SciencesUniversity of PittsburghPittsburghPA
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Donofry SD, Winograd D, Kothari D, Call CC, Magee KE, Jouppi RJ, Conlon RPK, Levine MD. Mindfulness in Pregnancy and Postpartum: Protocol of a Pilot Randomized Trial of Virtually Delivered Mindfulness-Based Cognitive Therapy to Promote Well-Being during the Perinatal Period. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:622. [PMID: 38791836 PMCID: PMC11121592 DOI: 10.3390/ijerph21050622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND During the period from pregnancy through the first year postpartum, vulnerable individuals are at elevated risk for the onset or worsening of psychological distress, and accessible (e.g., virtually delivered) mental health interventions are needed. Research suggests that Mindfulness-Based Cognitive Therapy (MBCT) can effectively mitigate psychological distress, although few studies have evaluated MBCT in the perinatal period, and samples have been clinically homogenous. Thus, we have designed and are conducting a pilot trial of virtually delivered MBCT with pregnant individuals experiencing a range of psychological symptoms to assess its feasibility and preliminarily explore its effectiveness. Here, we present the study protocol. METHODS Eligible participants (target N = 70) are ≥18 years with pregnancies between 12 and 30 weeks of gestation. Participants complete a diagnostic interview, self-report symptom ratings, and a computerized cognitive battery assessing self-regulation at the baseline. Participants are then randomized to either MBCT or care as usual. The MBCT intervention involves eight weekly group sessions delivered virtually, with each session focusing on a mindfulness practice followed by group discussion and skill development. Participants in the intervention group are also encouraged to practice mindfulness skills between sessions. Participants in the control condition are provided with information about mindfulness and treatment resources. Baseline measures are repeated following the eight-week intervention period and at three months postpartum. CONCLUSIONS This pilot study is designed to evaluate the feasibility of virtually delivered MBCT and explore group differences in psychological symptoms during the perinatal period, and will lay the foundation for a larger clinical trial focused on optimizing this intervention to improve psychological functioning among diverse pregnant individuals.
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Affiliation(s)
- Shannon D. Donofry
- RAND, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Dayna Winograd
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Diva Kothari
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Christine C. Call
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Kelsey E. Magee
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Riley J. Jouppi
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Rachel P. Kolko Conlon
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Michele D. Levine
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Ladak Z, Grewal N, Kim MO, Small S, Leber A, Hemani M, Sun Q, Hamza DM, Laur C, Ivers NM, Falenchuk O, Volpe R. Equity in prenatal healthcare services globally: an umbrella review. BMC Pregnancy Childbirth 2024; 24:191. [PMID: 38468220 PMCID: PMC10926563 DOI: 10.1186/s12884-024-06388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/04/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Timely, appropriate, and equitable access to quality healthcare during pregnancy is proven to contribute to better health outcomes of birthing individuals and infants following birth. Equity is conceptualized as the absence of differences in healthcare access and quality among population groups. Healthcare policies are guides for front-line practices, and despite merits of contemporary policies striving to foster equitable healthcare, inequities persist. The purpose of this umbrella review is to identify prenatal healthcare practices, summarize how equities/inequities are reported in relation to patient experiences or health outcomes when accessing or using services, and collate equity reporting characteristics. METHODS For this umbrella review, six electronic databases were searched (Medline, EMBASE, APA PsychInfo, CINAHL, International Bibliography of the Social Sciences, and Cochrane Library). Included studies were extracted for publication and study characteristics, equity reporting, primary outcomes (prenatal care influenced by equity/inequity) and secondary outcomes (infant health influenced by equity/inequity during pregnancy). Data was analyzed deductively using the PROGRESS-Plus equity framework and by summative content analysis for equity reporting characteristics. The included articles were assessed for quality using the Risk of Bias Assessment Tool for Systematic Reviews. RESULTS The search identified 8065 articles and 236 underwent full-text screening. Of the 236, 68 systematic reviews were included with first authors representing 20 different countries. The population focus of included studies ranged across prenatal only (n = 14), perinatal (n = 25), maternal (n = 2), maternal and child (n = 19), and a general population (n = 8). Barriers to equity in prenatal care included travel and financial burden, culturally insensitive practices that deterred care engagement and continuity, and discriminatory behaviour that reduced care access and satisfaction. Facilitators to achieve equity included innovations such as community health workers, home visitation programs, conditional cash transfer programs, virtual care, and cross-cultural training, to enhance patient experiences and increase their access to, and use of health services. There was overlap across PROGRESS-Plus factors. CONCLUSIONS This umbrella review collated inequities present in prenatal healthcare services, globally. Further, this synthesis contributes to future solution and action-oriented research and practice by assembling evidence-informed opportunities, innovations, and approaches that may foster equitable prenatal health services to all members of diverse communities.
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Affiliation(s)
- Zeenat Ladak
- University of Toronto, Toronto, Canada.
- Women's College Hospital Institute for Health System Solutions & Virtual Care, Toronto, Canada.
| | | | | | | | | | | | - Qiuyu Sun
- University of Alberta, Edmonton, Canada
| | | | - Celia Laur
- University of Toronto, Toronto, Canada
- Women's College Hospital Institute for Health System Solutions & Virtual Care, Toronto, Canada
| | - Noah M Ivers
- University of Toronto, Toronto, Canada
- Women's College Hospital Institute for Health System Solutions & Virtual Care, Toronto, Canada
- Women's College Hospital, Toronto, Canada
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Donofry SD, Jouppi RJ, Call CC, Conlon RPK, Levine MD. Improvements in cardiovascular health over the perinatal period predicts lower postpartum psychological distress. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.22.23300475. [PMID: 38234856 PMCID: PMC10793538 DOI: 10.1101/2023.12.22.23300475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Background Adverse cardiovascular events during pregnancy (e.g., pre-eclampsia) occur at higher rates among individuals with pre-pregnancy overweight or obesity (body mass index [BMI]≥25kg/m2) and have been associated with postpartum depression. However, it is unclear whether cardiovascular health (CVH), defined more holistically than the absence of cardiovascular conditions in pregnancy, relates to postpartum psychological functioning. The present study examined whether changes in CVH during the perinatal period predicted postpartum psychological functioning among individuals with pre-pregnancy BMI≥25kg/m2. Methods Individuals (N=226; Mage=28.43±5.4 years; MBMI=34.17±7.15kg/m2) were recruited when their pregnancies were 12-20 weeks gestation (M=15.64±2.45 weeks) for a longitudinal study of health and well-being. Participants completed the Center for Epidemiological Studies Depression Scale (CES-D) and Perceived Stress Scale (PSS) and reported on CVH behaviors (dietary intake, physical activity, nicotine exposure, and sleep) at baseline and at 6-months postpartum. BMI and CVH behaviors were coded according to the American Heart Association's Life's Essential 8 to create a CVH score at both timepoints. Linear regression analyses were performed to examine whether change in CVH related to postpartum CES-D and PSS scores. Because sleep was only measured in a subset of participants (n=114), analyses were conducted with and without sleep included. Baseline CVH, CES-D and PSS scores, and demographic factors were included as covariates in all models. Results Improved CVH was associated with lower postpartum CES-D (β=-0.18, p<0.01) and PSS (β=-0.13, p=0.02) scores when excluding sleep. Compared to those whose CVH improved by >1SD from pregnancy to 6-months postpartum, individuals whose CVH worsened by >1SD scored 6.42 points higher on the CESD (MCESD=15.25±10.92 vs. 8.52±6.90) and 6.12 points higher on the PSS (MPSS=24.45±8.29 vs. 17.83±8.70). However, when including sleep, these relationships were no longer significant (ps>0.4). Conclusions Improvements in CVH from early pregnancy to 6-months postpartum were associated with lower postpartum depressive symptoms and perceived stress. However, these relationships were no longer significant when including sleep in the CVH metric, potentially due to the large reduction in sample size. These data suggest that intervening during pregnancy to promote CVH may improve postpartum psychological functioning among high-risk individuals.
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Affiliation(s)
- Shannon D. Donofry
- RAND Corporation, Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Riley J. Jouppi
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Christine C. Call
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Michele D. Levine
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA
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Goyal D, Dol J, Leckey M, Naraine S, Dennis CL, Chan EK, Basu G. Scoping Review of Racial and Ethnic Representation of Participants in Mental Health Research Conducted in the Perinatal Period During the COVID-19 Pandemic. J Obstet Gynecol Neonatal Nurs 2023; 52:117-127. [PMID: 36462529 PMCID: PMC9710717 DOI: 10.1016/j.jogn.2022.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To identify the racial and ethnic representation of participants in mental health research conducted in the perinatal period during the COVID-19 pandemic. DATA SOURCES MEDLINE, CINAHL, Cochrane Library, PsycINFO, Scopus, Web of Science. STUDY SELECTION We included peer-reviewed research articles in which researchers reported mental health outcomes of women during the perinatal period who were living in the United States or Canada during the COVID-19 pandemic. We included 25 articles in the final review. DATA EXTRACTION We extracted the citation, publication date, design, aim, country of origin, participant characteristics, sampling method, method of measurement of race and ethnicity, and mental health outcome(s). DATA SYNTHESIS The combined racial and ethnic representation of the 16,841 participants in the included studies was White (76.5%), Black (9.8%), other/multiracial (6.2%), Asian (3.9%), Hispanic/Latina (2.6%), Indigenous or Ethnic Minority Canadian (0.9%), and Native American or Alaska Native (0.1%). Most studies were conducted in the United States, used a cross-sectional design, and incorporated social media platforms to recruit participants. Depression, anxiety, and stress were the most frequently assessed mental health outcomes. CONCLUSION Relatively few women of color who were pregnant or in the postpartum period during the pandemic participated in mental health research studies. Future studies should develop intentional recruitment strategies to increase participation of women of color. Researchers should use updated guidance on reporting race and ethnicity to accurately represent every participant, minimize misclassification of women of color, and report meaningful results.
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Selvarajah S, Adil HS, Ekechi C. Race, ethnicity, and ill health: making the non-modifiable modifiable. Lancet 2022; 400:2008-2009. [PMID: 36502824 DOI: 10.1016/s0140-6736(22)02460-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Sujitha Selvarajah
- Race & Health, Institute for Global Health, University College London, London, UK; St George's Hospital NHS Foundation Trust, London, UK.
| | - Haleema Sadia Adil
- Race Equality Taskforce, Royal College of Obstetricians and Gynaecologists, London, UK; University College London Medical School, London, UK
| | - Christine Ekechi
- Queen Charlotte's & Chelsea Hospital, Imperial NHS Healthcare Trust, London, UK
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Torr C. Culturally competent care in the neonatal intensive care unit, strategies to address outcome disparities. J Perinatol 2022; 42:1424-1427. [PMID: 35241768 DOI: 10.1038/s41372-022-01360-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/09/2022] [Accepted: 02/17/2022] [Indexed: 11/09/2022]
Abstract
In the past two years, we have witnessed social unrest, the unequal effects of a pandemic across our society, and a focus on how systems in the United States produce unequal outcomes along racial and cultural divides. With increased national awareness, there has also been a call for change in healthcare, specifically racial inequities in Neonatal Intensive Care Unit (NICU) outcomes (1). While race may be a data point used to classify outcomes, it has no basis in biology, and merely identifying it does not make it simple to address. To address these inequities we need to look past the social construct of race and to the social aspects of our care in the NICU. Focusing on small and large changes that we can make as individuals, units, and as a specialty that can improve the care and outcomes of this at-risk patient population. This perspective focuses on culturally congruent care, trauma-informed care, and other approaches to reduce disparities in neonatal outcomes.
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Affiliation(s)
- Carrie Torr
- University of Utah School of Medicine, Salt Lake City, UT, USA.
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Patel M, Raphael JL. Acute care utilization disparities among publicly insured preterm infants. Pediatr Res 2021; 90:717-719. [PMID: 34545204 DOI: 10.1038/s41390-021-01703-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/04/2021] [Indexed: 01/30/2023]
Affiliation(s)
- Mona Patel
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Jean L Raphael
- Center for Child Health Policy and Advocacy, Baylor College of Medicine, Houston, TX, USA
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Jatta F, Sundby J, Vangen S, Lindskog BV, Sørbye IK, Owe KM. Association between Maternal Origin, Pre-Pregnancy Body Mass Index and Caesarean Section: A Nation-Wide Registry Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115938. [PMID: 34205921 PMCID: PMC8197892 DOI: 10.3390/ijerph18115938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 02/03/2023]
Abstract
Aims: To explore the association between maternal origin and birthplace, and caesarean section (CS) by pre-pregnancy body mass index (BMI) and length of residence. Methods: We linked records from 118,459 primiparous women in the Medical Birth Registry of Norway between 2013 and 2017 with data from the National Population Register. We categorized pre-pregnancy BMI (kg/m2) into underweight (<18.5), normal weight (18.5–24.9) and overweight/obese (≥25). Multinomial regression analysis estimated crude and adjusted relative risk ratios (RRR) with 95% confidence intervals (CI) for emergency and elective CS. Results: Compared to normal weight women from Norway, women from Sub-Saharan Africa and Southeast Asia/Pacific had a decreased risk of elective CS (aRRR = 0.57, 95% CI 0.37–0.87 and aRRR = 0.56, 0.41–0.77, respectively). Overweight/obese women from Europe/Central Asia had the highest risk of elective CS (aRRR = 1.42, 1.09–1.86). Both normal weight and overweight/obese Sub-Saharan African women had the highest risks of emergency CS (aRRR = 2.61, 2.28-2.99; 2.18, 1.81-2.63, respectively). Compared to women from high-income countries, the risk of elective CS was increasing with a longer length of residence among European/Central Asian women. Newly arrived migrants from Sub-Saharan Africa had the highest risk of emergency CS. Conclusion: Women from Sub-Saharan Africa had more than two times the risk of emergency CS compared to women originating from Norway, regardless of pre-pregnancy BMI.
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Affiliation(s)
- Fatou Jatta
- Institute of Health and Society, Department of Community Medicine and Global Health, University of Oslo, 0317 Oslo, Norway; (F.J.); (J.S.)
| | - Johanne Sundby
- Institute of Health and Society, Department of Community Medicine and Global Health, University of Oslo, 0317 Oslo, Norway; (F.J.); (J.S.)
| | - Siri Vangen
- Norwegian Research Centre for Women’s Health, Department of Obstetrics and Gynecology, Oslo University Hospital, 0424 Oslo, Norway; (S.V.); (I.K.S.)
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | | | - Ingvil Krarup Sørbye
- Norwegian Research Centre for Women’s Health, Department of Obstetrics and Gynecology, Oslo University Hospital, 0424 Oslo, Norway; (S.V.); (I.K.S.)
| | - Katrine Mari Owe
- Norwegian Research Centre for Women’s Health, Department of Obstetrics and Gynecology, Oslo University Hospital, 0424 Oslo, Norway; (S.V.); (I.K.S.)
- Department of Child health and development, Norwegian Institute of Public Health, 0213 Oslo, Norway
- Correspondence: ; Tel.: +47-91683023
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