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Aliasghari F, Effati-Daryani F, Mohammadi A, Mirghafourvand M. Relationship of domestic violence with pregnancy symptoms and pregnancy experience in Iranian pregnant women: a cross-sectional study. BMJ Open 2024; 14:e082570. [PMID: 38670608 PMCID: PMC11057274 DOI: 10.1136/bmjopen-2023-082570] [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: 11/28/2023] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE Violence has had adverse effects on the physical and psychological dimensions of pregnant women. This study was conducted with the aim of determining the relationship of domestic violence with pregnancy symptoms and pregnancy experience. DESIGN In this cross-sectional study, pregnant women were selected through two-stage cluster sampling method. Data were collected using the domestic violence questionnaire of the WHO, pregnancy symptoms inventory (PSI) and pregnancy experience scale (PES). To determine the relationship between domestic violence with pregnancy symptoms and pregnancy experience, adjusted general linear model was used in multivariate analysis. SETTING Health centres in Urmia-Iran in 2022. PARTICIPANTS 415 pregnant women. RESULTS The frequency of emotional, physical and sexual violence was 86.0%, 67.7% and 79.5%, respectively. The mean (SD) of PSI was 49.45 (14.38) with attainable score of 0-123 and PES including happiness and worry was 14.32 (6.48) and 16.21 (2.51) with attainable score of 0-30, respectively. Based on the adjusted general linear model, the mean score of PSI in women who experienced physical violence (mild (p<0.001) and moderate (p<0.001)); sexual violence (mild (p<0.001), moderate (p<0.001) and severe (p<0.001)); and emotional violence (mild (p<0.001), moderate (p=0.002) and severe (p<0.001)) was significantly higher than women without experiencing violence. The mean score of happiness during pregnancy in women who experienced physical violence (moderate (p=0.011)) and emotional violence (mild (p<0.001), moderate (p=0.002) and severe (p<0.001)) was significantly lower than women without experience of violence. Also, the mean score of worry scores in women with experience of sexual violence (mild (p=0.001) and moderate (p=0.012)) and emotional violence (mild (p<0.001), moderate (p<0.001)) and severe (p<0.001)) was significantly higher than women without experiencing violence. CONCLUSION Considering the relationship between violence and pregnancy symptoms and pregnancy experiences, it is necessary to use appropriate strategies to prevent violence in pregnant women.
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Affiliation(s)
- Fatemeh Aliasghari
- Nursing and Midwifery Faculty, Urmia University of Medical Sciences, Urmia, The Islamic Republic of Iran
| | - Fatemeh Effati-Daryani
- Midwifery Department, Urmia University of Medical Sciences, Urmia, The Islamic Republic of Iran
| | - Azam Mohammadi
- Iran University of Medical Sciences, Tehran, The Islamic Republic of Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, The Islamic Republic of Iran
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Parisi F, Høifødt RS, Bohne A, Wang CEA, Pfuhl G. Perceived Parenting Stress Is Related to Cardiac Flexibility in Mothers: Data from the NorBaby Study. Behav Sci (Basel) 2024; 14:117. [PMID: 38392470 PMCID: PMC10886085 DOI: 10.3390/bs14020117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/20/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
Heart rate variability (HRV) is an indicator of autonomic nervous system activity, and high levels of stress and/or depressive symptoms may reduce HRV. Here, we assessed whether (a) parental stress affected HRV in mothers during the perinatal period and whether this is mediated by bonding and (b) whether antenatal maternal mental states, specifically repetitive negative thinking, depressive symptoms, and pregnancy-related anxiety, have an impact on infant HRV, and lastly, we investigated (c) the relationship between maternal HRV and infant HRV. Data are from the Northern Babies Longitudinal Study (NorBaby). In 111 parent-infant pairs, cardiac data were collected 6 months after birth. In the antenatal period, we used the Pregnancy-Related Anxiety Questionnaire-Revised, the Edinburgh Postnatal Depression Scale, and the Perseverative Thinking Questionnaire; in the postnatal period, we used the Parenting Stress Index and the Maternal Postnatal Attachment Scale. Higher levels of perceived parenting stress but not depressive symptoms were associated with lower HRV in mothers (τ = -0.146), and this relationship was not mediated by maternal bonding. Antenatal maternal mental states were not associated with infant HRV. There was no significant correlation between maternal HRV and infant HRV. Our observational data suggest that perceived stress reduces cardiac flexibility. Future studies should measure HRV and parenting stress repeatedly during the perinatal period.
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Affiliation(s)
- Francesca Parisi
- Department of Psychology, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | | | - Agnes Bohne
- Department of Psychology, UiT the Arctic University of Norway, 9019 Tromsø, Norway
- Division of Child and Adolescent Health, University Hospital of Northern Norway, 9019 Tromsø, Norway
| | | | - Gerit Pfuhl
- Department of Psychology, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Department of Psychology, UiT the Arctic University of Norway, 9019 Tromsø, Norway
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Bruinhof N, Sehic E, Hancock GR, Gartstein MA, de Weerth C. Prenatal anticipatory stress: Baby preparation and worry scale-revised in the Dutch context. Compr Psychiatry 2024; 128:152437. [PMID: 38007905 DOI: 10.1016/j.comppsych.2023.152437] [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: 08/16/2023] [Revised: 10/20/2023] [Accepted: 11/07/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Prenatal distress encompasses a range of different emotions, worries, and experiences of stress. The Baby Preparation and Worry Scale (Baby-PAWS) was recently developed to target anticipatory worries during pregnancy about the postnatal period. However, the Baby-PAWS questionnaire was only examined in the United States of America, limiting the questionnaire's generalizability to different countries. To address this issue, we performed a psychometric evaluation of the questionnaire in a Dutch sample and examined associations between the Baby-PAWS questionnaire and established measures of maternal distress (i.e., EPDS, STAI, PRAQ-R) and infant temperament (i.e., IBQ-R). METHODS Healthy pregnant women (N = 521) completed questionnaires during their third trimester and postnatally, including the Baby-PAWS and distress measures. A subsample of mothers (N = 194) also reported on infant temperament at 12 weeks postpartum. RESULTS Exploratory factor analysis suggested a four-factor structure for the 16-item questionnaire in our Dutch sample, as compared to the expected three-factor structure found in the original psychometric evaluation with the American sample. The total Baby-PAWS score was related to pre-and postnatal depression, anxiety, stress, and specific scales of infant temperament. American women scored higher on the Baby-PAWS items than Dutch women. LIMITATIONS Our participants had higher-than-average socioeconomic status, limiting the generalizability of the findings. CONCLUSION The current analyses indicate good validity of the Baby-PAWS in a Dutch sample. Furthermore, our results highlight cross-cultural differences in perinatal mental health and show the importance of examining instrument structure of context-dependent constructs, such as prenatal worries.
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Affiliation(s)
- Nina Bruinhof
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, P.O. Box 9010, 6500, GL, Nijmegen, the Netherlands.
| | - Ela Sehic
- Washington State University, Department of Psychology, Pullman, WA, United States of America.
| | | | - Maria A Gartstein
- Washington State University, Department of Psychology, Pullman, WA, United States of America.
| | - Carolina de Weerth
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, P.O. Box 9010, 6500, GL, Nijmegen, the Netherlands.
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Gerges S, Obeid S, Hallit S. Traversing mental health disorders during pregnancy: Lebanese women's experiences of antepartum depression and anxiety. Ir J Med Sci 2023; 192:2949-2959. [PMID: 37081286 PMCID: PMC10117264 DOI: 10.1007/s11845-023-03371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
INTRODUCTION Over the past few years, Lebanon-a developing country-has faced a plethora of economic and political challenges, with more than half of the general population presenting depressive and anxiety symptoms. However, when it comes to maternal mental health during pregnancy, the last examination in Lebanon dates far back to 2005. Our study's aim was to help delineate the factors associated with Lebanese women's mental health disorders during pregnancy, namely antepartum depression and anxiety. METHODS We launched a cross-sectional study among Lebanese pregnant women (age ≥ 18 years) between June and July 2021, during the COVID-19 lockdown (N = 433). RESULTS In total, 87.8% of the participants experienced depression (mild to severe), where severe depression was observed in 7.9%. In addition, 70.3% had a significant level of anxiety. Increased pregnancy-specific hassles (beta = 0.93), being Muslim compared to Christians (beta = 3.19), being afraid of an existing aggressor (beta = 8.75), urinary tract infections (beta = 2.02), and higher gestational age (beta = 0.07) were significantly associated with higher depression, whereas higher physical activity index (beta = - 0.09) and increased disordered eating attitudes during pregnancy (beta = - 0.27) were significantly associated with less depression, all accounting for 60.4% of the model's variance. Additionally, increased pregnancy-specific hassles (beta = 0.54), being Muslim compared to Christians (beta = 2.42), urinary tract infections (beta = 1.72), and having been emotionally or physically abused (beta = 1.19) were significantly associated with higher levels of anxiety and could predict 49% of the total variance. CONCLUSION Our study has suggested the existence of factors that have additive effects in potentiating the risk for depression and anxiety among Lebanese pregnant women, namely cultural beliefs, pregnancy-related distress, medical complications during pregnancy, and a history of abuse. Therefore, it would be judicious to implement screening programs targeting pregnant women at risk for antepartum depression and anxiety. In addition, high rates of prenatal depression and anxiety were detected among our sample, supporting that recognizing and treating maternal mental health disorders should be prioritized during antenatal care in Lebanon.
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Affiliation(s)
- Sarah Gerges
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Research Department, Psychiatric Hospital of the Cross, Jal-Eddib, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
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Gerges S, DiPietro JA, Obeid S, Fekih-Romdhane F, Hallit S. Psychometric performance assessment of the Arabic version of the pregnancy experience scale-brief version (PES-brief) in an Arabic-speaking population. J Psychosom Res 2023; 174:111499. [PMID: 37801881 DOI: 10.1016/j.jpsychores.2023.111499] [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: 06/24/2023] [Revised: 09/17/2023] [Accepted: 09/22/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE Although tools exist to assess psychological distress during pregnancy, a scarcity of instruments are designed to measure maternal perceptions of the more positive, uplifting features of pregnancy in addition to the more negative, hassling aspects. To address this shortcoming, DiPietro et al. developed the Pregnancy Experience Scale-Brief (PES-Brief). We aimed to assess the reliability and psychometric performance of an Arabic translation of the PES-Brief among Lebanese pregnant women. METHODS The PES-Brief, the Patient Health Questionnaire, the Lebanese Anxiety Scale, and the Multidimensional Scale of Perceived Social Support were administered to 433 participants. PES-Brief scores were computed as frequency and intensity, with Hassles to Uplifts frequency and intensity ratios. RESULTS The PES-Brief was internally consistent, with McDonald's ω = 0.87 for Uplifts and 0.81 for Hassles. Higher PES-Uplifts scores were significantly associated with lower depression and anxiety scores, and higher perceived social support; whereas higher PES-Hassles scores showed inverse correlations. The Hassles to Uplifts frequency and intensity ratios were 0.864 and 0.836, respectively, indicating that pregnant women were more uplifted than hassled. The CFA results confirmed the two-factor structure of the scale. CONCLUSION Our findings suggest that the Arabic PES-Brief is a psychometrically valid and reliable scale that may be employed as a legitimate indicator of pregnancy-specific uplifts and hassles among Arabic-speaking populations. Our study prompts clinicians and researchers to benefit from this tool for capturing the integral psychological/emotional experience of women during pregnancy, which may facilitate pregnant women's support when needed.
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Affiliation(s)
- Sarah Gerges
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. box 446, Jounieh, Lebanon.
| | - Janet A DiPietro
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of psychiatry "Ibn Omrane", Razi Hospital, Manouba 2010, Tunisia; Tunis El Manar University, Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. box 446, Jounieh, Lebanon; Applied Science Research Center, Applied Science Private University, Amman, Jordan; Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
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Keenan-Devlin LS, Borders AEB, Freedman A, Miller GE, Grobman W, Entringer S, Simhan H, Wadhwa P, Buss C. Maternal exposure to childhood maltreatment and adverse birth outcomes. Sci Rep 2023; 13:10380. [PMID: 37369688 DOI: 10.1038/s41598-023-36831-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
Exposure to traumatic events during pregnancy may influence pregnancy and birth outcomes. Growing evidence suggests that exposure to traumatic events well before pregnancy, such as childhood maltreatment (CM), also may influence the course of pregnancy and risk of adverse birth outcomes. We aimed to estimate associations between maternal CM exposure and small-for-gestational-age birth (SGA) and preterm birth (PTB) in a diverse US sample, and to examine whether common CM-associated health and behavioral sequelae either moderate or mediate these associations. The Measurement of Maternal Stress (MOMS) Study was a prospective cohort study that enrolled 744 healthy English-speaking participants ≥ 18 years with a singleton pregnancy, who were < 21 weeks at enrollment, between 2013 and 2015. CM was measured via the Childhood Trauma Questionnaire (CTQ) and participants above the moderate/severe cut-off for any of the five childhood abuse and neglect scales were assigned to the CM-exposed group. Common CM-associated health (obesity, depressive symptoms, hypertensive disorders) and behavioral (substance use) sequelae were obtained from standardized questionnaires and medical records. The main outcomes included PTB (gestational age < 37 weeks at birth) and SGA (birthweight < 10%ile for gestational age) abstracted from the medical record. Multivariable logisitic regression was used to test associations between CM, sequeale, and birth outcomes, and both moderation and mediation by CM-related sequelae were tested. Data were available for 657/744 participants. Any CM exposure was reported by 32% of participants. Risk for SGA birth was 61% higher among those in the CM group compared to the non-CM group (14.1% vs. 7.6%), and each subsequent form of CM that an individual was exposed to corresponded with a 27% increased risk for SGA (aOR 1.27, 95% CI 1.05, 1.53). There was no significant association between CM and PTB (9.3% vs. 13.0%, aOR 1.07, 95% CI 0.58, 1.97). Of these sequelae only hypertensive disorders were associated with both CM and SGA and hypertensive disorders of pregnancy did not mediate the association between CM and SGA. Our findings indicate that maternal CM exposure is associated with increased risk for SGA birth and highlight the importance of investigating the mechanisms whereby childhood adversity sets the trajectory for long-term and intergenerational health issues.
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Affiliation(s)
- Lauren S Keenan-Devlin
- , Evanston, IL, USA
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, USA
- University of Chicago Pritzker School of Medicine, Chicago, USA
| | - Ann E B Borders
- , Evanston, IL, USA
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, USA
- University of Chicago Pritzker School of Medicine, Chicago, USA
- Institute for Public Health and Medicine, Northwestern University Center for Healthcare Studies, Chicago, USA
| | - Alexa Freedman
- , Evanston, IL, USA
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, USA
- Department of Psychology, Northwestern University, Evanston, USA
- Institute for Policy Research, Northwestern University, Evanston, USA
| | - Gregory E Miller
- , Evanston, IL, USA
- Department of Psychology, Northwestern University, Evanston, USA
- Institute for Policy Research, Northwestern University, Evanston, USA
| | - William Grobman
- Institute for Public Health and Medicine, Northwestern University Center for Healthcare Studies, Chicago, USA
- , Chicago, IL, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Evanston, USA
| | - Sonja Entringer
- , Berlin, Germany
- Department of Medical Psychology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Development, Health and Disease Research Program, UC University of California Irvine, California, USA
| | - Hyagriv Simhan
- , Pittsburgh, PA, USA
- Division of Maternal-Fetal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Pathik Wadhwa
- Development, Health and Disease Research Program, UC University of California Irvine, California, USA
- , Irvine, CA, USA
| | - Claudia Buss
- , Berlin, Germany.
- Department of Medical Psychology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- Development, Health and Disease Research Program, UC University of California Irvine, California, USA.
- Department of Pediatrics, Development, Health and Disease Research Program, University of California Irvine, 1001 Health Sciences Road, Irvine, CA, 92697-3950, USA.
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Alves AC, Souza RT, Mayrink J, Galvao RB, Costa ML, Feitosa FE, Rocha Filho EA, Leite DF, Tedesco RP, Santana DS, Fernandes KG, Miele MJ, Souza JP, Cecatti JG. Measuring resilience and stress during pregnancy and its relation to vulnerability and pregnancy outcomes in a nulliparous cohort study. BMC Pregnancy Childbirth 2023; 23:396. [PMID: 37248450 DOI: 10.1186/s12884-023-05692-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 05/09/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Resilience reflects coping with pregnancy-specific stress, including physiological adaptations of the maternal organism or factors arising from the socioeconomic context, such as low income, domestic violence, drug and alcohol use, lack of a support network and other vulnerability characteristics. Resilience is a dynamic characteristic that should be comparatively evaluated within a specific context; its association with perceived stress and social vulnerability during pregnancy is still not fully understood. This study aimed at exploring maternal resilience, perceived stress and social vulnerability during pregnancy and its associated factors and outcomes. METHODS Prospective multicenter cohort study of nulliparous women in Brazil determining resilience (Resilience Scale; RS) and stress (Perceived Stress Scale; PSS) at 28 weeks of gestation (± 1 week). Resilience and stress scores were compared according to sociodemographic characteristics related to maternal/perinatal outcomes and social vulnerability, defined as having low level of education, being adolescent, without a partner or ethnicity other than white. RESULTS We included 383 women who completed the RS and PSS instruments. Most women showed low resilience scores (median: 124.0; IQR 98-143). Women with a low resilience score (RS < 125) were more likely from the Northeast region, adolescents, other than whites, did not study or work, had a low level of education, low family income and received public antenatal care. Higher scores of perceived stress were shown in the Northeast, other than whites, at low levels of education, low annual family income and public antenatal care. Pregnant women with low resilience scores (n = 198) had higher perceived stress scores (median = 28) and at least one vulnerability criterion (n = 181; 91.4%). CONCLUSION Our results reinforce the role of resilience in protecting women from vulnerability and perceived stress. It may prevent complications and build a positive experience during pregnancy.
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Affiliation(s)
- Anic C Alves
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), 101 Alexander Fleming, Cidade Universitária, Campinas, SP, Brazil
| | - Renato T Souza
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), 101 Alexander Fleming, Cidade Universitária, Campinas, SP, Brazil
| | - Jussara Mayrink
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), 101 Alexander Fleming, Cidade Universitária, Campinas, SP, Brazil
| | - Rafael B Galvao
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), 101 Alexander Fleming, Cidade Universitária, Campinas, SP, Brazil
| | - Maria L Costa
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), 101 Alexander Fleming, Cidade Universitária, Campinas, SP, Brazil
| | | | - Edilberto A Rocha Filho
- Department of Gynecology and Obstetrics, Medical Sciences School, Federal University of Pernambuco, Recife, PE, Brazil
| | - Débora F Leite
- Department of Gynecology and Obstetrics, Medical Sciences School, Federal University of Pernambuco, Recife, PE, Brazil
| | - Ricardo P Tedesco
- Department of Obstetrics and Gynecology, Jundiaí Medical School, Jundiaí, SP, Brazil
| | - Danielly S Santana
- Department of Obstetrics and Gynecology, Jundiaí Medical School, Jundiaí, SP, Brazil
| | - Karayna G Fernandes
- Department of Obstetrics and Gynecology, Jundiaí Medical School, Jundiaí, SP, Brazil
| | - Maria J Miele
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), 101 Alexander Fleming, Cidade Universitária, Campinas, SP, Brazil
| | - Joao P Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, SP, Brazil
| | - Jose G Cecatti
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), 101 Alexander Fleming, Cidade Universitária, Campinas, SP, Brazil.
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Malik A, Park S, Mumtaz S, Rowther A, Zulfiqar S, Perin J, Zaidi A, Atif N, Rahman A, Surkan PJ. Perceived Social Support and Women's Empowerment and Their Associations with Pregnancy Experiences in Anxious Women: A Study from Urban Pakistan. Matern Child Health J 2023; 27:916-925. [PMID: 36746839 PMCID: PMC10121818 DOI: 10.1007/s10995-023-03588-6] [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] [Accepted: 01/18/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Psychological distress in pregnancy is associated with adverse postnatal outcomes. We aimed to identify how social support and women's empowerment are associated with pregnancy-specific daily experiences among women suffering antenatal anxiety in Pakistan. METHODS Data were collected as part of a randomized controlled trial of a psychosocial intervention for antenatal anxiety in a tertiary hospital in Pakistan. We included 594 women in early pregnancy (≤ 22 weeks) who endorsed mild to severe anxiety symptoms. Generalized linear regression models were used to analyze the associations of perceived social support and women's empowerment in relation to pregnancy-specific daily hassles and uplifts using a culturally adapted and psychometrically validated version of the Pregnancy Experience Scale-Brief. RESULTS High social support was positively associated with frequency and intensity of positive pregnancy-specific experiences (B = 0.39, 95% CI 0.23-0.54 uplifts frequency; and B = 0.17, 95% CI 0.12-0.22 uplifts intensity), and was inversely associated with frequency of negative pregnancy-specific experiences (B = - 0.44, 95% CI - 0.66, - 0.22). Women's household empowerment was associated with greater uplifts frequency and intensity (B = 0.55, 95% CI 0.20-0.90 frequency; and B = 0.28, 95% CI 0.17-0.40 intensity). High social support and household empowerment were inversely related to PES hassle-to-uplift ratio scores. CONCLUSIONS FOR PRACTICE Greater social support and household empowerment were associated with positive pregnancy-specific experiences in the context of antenatal anxiety in Pakistan.
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Affiliation(s)
- Abid Malik
- Human Development Research Foundation, House No 06, Street No 55, F-7/4, 44000, Islamabad, Pakistan
- Health Services Academy, Park Road, Chack shahzad, Islamabad, Pakistan
| | - Soim Park
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., MD, 21205, Baltimore, USA
| | - Sidra Mumtaz
- Human Development Research Foundation, House No 06, Street No 55, F-7/4, 44000, Islamabad, Pakistan
| | - Armaan Rowther
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., MD, 21205, Baltimore, USA
| | - Shaffaq Zulfiqar
- Human Development Research Foundation, House No 06, Street No 55, F-7/4, 44000, Islamabad, Pakistan
| | - Jamie Perin
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., MD, 21205, Baltimore, USA
| | - Ahmed Zaidi
- Human Development Research Foundation, House No 06, Street No 55, F-7/4, 44000, Islamabad, Pakistan
| | - Najia Atif
- Human Development Research Foundation, House No 06, Street No 55, F-7/4, 44000, Islamabad, Pakistan
| | - Atif Rahman
- Institute of Population Health, University of Liverpool, Liverpool, L12 2AP, UK
| | - Pamela J Surkan
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., MD, 21205, Baltimore, USA.
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Rheinheimer N, Beijers R, Bruinhof N, Cooijmans KHM, de Weerth C. Effects of daily full-term infant skin-to-skin contact on behavior and cognition at age three - secondary outcomes of a randomized controlled trial. J Child Psychol Psychiatry 2023; 64:136-144. [PMID: 35942886 PMCID: PMC10087794 DOI: 10.1111/jcpp.13679] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Daily skin-to-skin contact (SSC) during early infancy fosters the long-term development of children born preterm. This is the first randomized controlled trial assessing the potential beneficial effects of daily SSC on executive functioning and socio-emotional behavior of children born full-term. Whether children of mothers who experienced prenatal stress and anxiety benefitted more from SSC was also explored. METHODS Pregnant women (N = 116) were randomly assigned to a SSC or care-as-usual (CAU) condition. Women in the SSC condition were instructed to perform one hour of SSC daily from birth until postnatal week five. Prenatal stress was measured with questionnaires on general and pregnancy-specific stress and anxiety completed by the mothers in gestational week 37. At child age three, mothers filled in questionnaires on children's executive functioning, and externalizing and internalizing behavior. Analyses were performed in an intention-to-treat (ITT), per-protocol, and dose-response approach. Netherlands Trial Register: NL5591. RESULTS In the ITT approach, fewer internalizing (95% CI = 0.11-1.00, U = 2148.50, r = .24, p = .001) and externalizing (95% CI = 0.04-2.62, t = 2.04, d = 0.38, p = .04) problems were reported in the SSC condition compared to the CAU condition. Multivariate analyses of variance did not show group differences on executive functioning. Additional analyses of covariance showed no moderations by maternal prenatal stress. CONCLUSIONS Current findings indicate that early daily SSC in full-term infants may foster children's behavioral development. Future replications, including behavioral observations of child behavior to complement maternal reports, are warranted.
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Affiliation(s)
- Nicole Rheinheimer
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roseriet Beijers
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Social Development, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Nina Bruinhof
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Social Development, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Kelly H M Cooijmans
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Social Development, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Carolina de Weerth
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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10
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Zaidi A, Khan A, Rowther A, Nazir H, Perin J, Rauf N, Mumtaz S, Naseem H, Atif N, Rahman A, Surkan PJ, Malik A. Cultural adaptation and psychometric validation of the Pregnancy Experience Scale–Brief version (PES-Brief) in Pakistani women with antenatal anxiety symptoms. SSM - MENTAL HEALTH 2022; 2. [PMID: 36969715 PMCID: PMC10035068 DOI: 10.1016/j.ssmmh.2021.100055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Pregnancy experiences influence fetal and birth outcomes. There is scarcity of locally validated tools to assess pregnancy experiences. We aimed to validate the Pregnancy Experience Scale-Brief (PES-Brief) in pregnant Pakistani women with anxiety symptoms. Methods A two-step process was used including 1) adaptation via translation/back-translation followed by cognitive interviewing with 10 participants and 2) factor analysis and validation with 605 women in Rawalpindi Pakistan who had mild-moderate symptoms of anxiety, attended the antenatal clinic, and were ≤22 weeks of gestation and ≥18 years old. We calculated internal consistency and reliability and conducted exploratory and confirmatory factor analyses. Results Cultural adaptation led to inclusion of one item of the hassles subscale and exclusion of one item in the uplifts subscale, resulting in 9 uplifts and 11 hassles. Exploratory factor analysis supported a two-factor structure, with the adapted items exhibiting loading values of ≥0.24 for their respective factors. Internal consistency was demonstrated for uplifts (Cronbach's alpha = 0.89) and hassles (Cronbach's alpha = 0.85) subscales. Uplift intensity was moderately correlated with the Hospital Anxiety and Depression Scale anxiety subscale (r = 0.54, 95% CI:0.30-0.77). Conclusion The Urdu PES-Brief is a reliable and valid tool for use in Pakistani pregnant women with antenatal anxiety. Future studies on its validity are needed on women without symptoms anxiety.
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Affiliation(s)
- Ahmed Zaidi
- Human Development Research Foundation, House No 06, Street No 55, F-7/4, Islamabad, 44000, Pakistan
- Corresponding author. (A. Zaidi)
| | - Aasia Khan
- Human Development Research Foundation, House No 06, Street No 55, F-7/4, Islamabad, 44000, Pakistan
| | - Armaan Rowther
- Department of International Health, Johns Hopkins Bloomberg School of Public Health 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Huma Nazir
- Human Development Research Foundation, House No 06, Street No 55, F-7/4, Islamabad, 44000, Pakistan
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Nida Rauf
- Human Development Research Foundation, House No 06, Street No 55, F-7/4, Islamabad, 44000, Pakistan
| | - Sidra Mumtaz
- Human Development Research Foundation, House No 06, Street No 55, F-7/4, Islamabad, 44000, Pakistan
| | - Hina Naseem
- Human Development Research Foundation, House No 06, Street No 55, F-7/4, Islamabad, 44000, Pakistan
| | - Najia Atif
- Human Development Research Foundation, House No 06, Street No 55, F-7/4, Islamabad, 44000, Pakistan
| | - Atif Rahman
- University of Liverpool, Institute of Population Health, University of Liverpool, Liverpool, L12 2AP, UK
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Abid Malik
- Human Development Research Foundation, House No 06, Street No 55, F-7/4, Islamabad, 44000, Pakistan
- Rawalpindi Medical University, Tipu Rd, Chamanzar Colony, Rawalpindi, Punjab, 46000, Pakistan
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11
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Williams CE, Berkowitz D, Rackin HM. Exploring the experiences of pregnant women in the U.S. during the first year of the Covid-19 pandemic. THE JOURNAL OF SOCIAL ISSUES 2022; 79:JOSI12567. [PMID: 36718412 PMCID: PMC9877755 DOI: 10.1111/josi.12567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 10/01/2022] [Accepted: 10/02/2022] [Indexed: 06/18/2023]
Abstract
In this paper, we integrate the stress process model with symbolic interactionism to frame our analysis of interviews with 35 women who were pregnant and/or gave birth during the first year of the Covid-19 pandemic. We detail three stressors, highlight their variation, and discuss how they coped with these stressors. Women reported having to navigate contradictory information about the public health crisis, but Black participants simultaneously endured added strain from a heightened awareness of racialized violence. To cope with an overabundance of precarious and contradictory messages, some women sought out information (i.e., information gatherers), others eschewed information (i.e., information avoiders), and most established protective "bubbles." Next, women experienced disruptions in pregnancy rituals but coped by reframing their expectations. This stressor, however, was less acute for women with a prior birth. Third, women shared feelings of social isolation and reduced social support, which were intensified if pregnancy complications occurred. Women coped by relying on telecommunication and at-home monitoring devices. Our study shows how pregnant women experienced and coped through adversity to mitigate stressors amid pandemonium.
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Affiliation(s)
| | - Dana Berkowitz
- Department of SociologyLouisiana State UniversityBaton RougeLouisianaUSA
| | - Heather M. Rackin
- Department of SociologyLouisiana State UniversityBaton RougeLouisianaUSA
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12
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Yeşilçinar İ, Şahin E, Güvenç G. Turkish version of the pregnancy experience scale-brief: validity and reliability study. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2022. [DOI: 10.15452/cejnm.2022.13.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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13
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Reich SM, Tulagan N, Dahlin M, Labaff S, Dutt N, Rahmani A. Pregnant in a Pandemic: Connecting Perceptions of Uplifts and Hassles to Mental Health. J Health Psychol 2022:13591053221120115. [PMID: 36036227 DOI: 10.1177/13591053221120115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
How women experience pregnancy as uplifting or a hassle is related to their mental and physical health and birth outcomes. Pregnancy during a pandemic introduces new hassles, but may offer benefits that could affect how women perceive their pregnancy. Surveying 118 ethnically and racially diverse pregnant women, we explore (1) women's traditional and pandemic-related pregnancy uplifts and hassles and (2) how these experiences of pregnancy relate to their feelings of loneliness, positivity, depression, and anxiety. Regressions show that women who experience more intense feelings of uplifts than hassles also feel more positive, less lonely, and have better mental health. Findings suggest that focusing on positive aspects of being pregnant, in general and during a pandemic, might be beneficial for pregnant women's mental health.
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Affiliation(s)
| | | | | | | | - Nikil Dutt
- University of California, Irvine, CA, USA
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14
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Liu CH, Hyun S, Erdei C, Mittal L. Prenatal distress during the COVID-19 pandemic: clinical and research implications. Arch Gynecol Obstet 2022; 306:397-405. [PMID: 34716818 PMCID: PMC8556835 DOI: 10.1007/s00404-021-06286-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 10/13/2021] [Indexed: 12/03/2022]
Abstract
PURPOSE The objective of this study was to identify risk and protective factors related to general prenatal distress and COVID-19-specific prenatal distress to inform intervention targets among women pregnant during the COVID-19 pandemic. METHODS The study relied on data obtained from U.S. pregnant women (N = 701) who participated in the Perinatal Experiences and COVID-19 Effects (PEACE) Study from May 21 to October 3, 2020. The present cross-sectional study examined the potential risk and protective factors associated with different features of prenatal distress among U.S. pregnant women during the COVID-19 pandemic. RESULTS Approximately two-thirds of expectant mothers indicated being more stressed about going to the hospital because of COVID-19. Generalized anxiety and PTSD were associated with higher levels of general and COVID-19-specific prenatal distress. Depression symptoms were associated with higher general prenatal distress. Higher levels of distress tolerance were associated with lower levels of general prenatal distress (B = - 0.192, p < .001) and COVID-19-specific prenatal distress (B = - 0.089, p < .05). Higher levels of instrumental social support were marginally associated with lower COVID-19-specific prenatal distress (B = - 0.140, p < 0.1). CONCLUSION Findings draw attention to prenatal distress experiences during the COVID-19 pandemic, including new types of distress arising from the pandemic itself. Women might benefit from the introduction of interventions such as mindfulness-based or relaxation therapy. Coverage of responsibilities and financial assistance is particularly needed during the COVID-19 pandemic. Limitations include a majority White and high socioeconomic sample. These findings provide specificity regarding potential targets for addressing prenatal distress.
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Affiliation(s)
- Cindy H Liu
- Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Sunah Hyun
- Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Carmina Erdei
- Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Leena Mittal
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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15
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It takes two: An antenatal to postnatal RDoC framework for investigating the origins of maternal attachment and mother–infant social communication. Dev Psychopathol 2021; 33:1539-1553. [DOI: 10.1017/s0954579421000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractTransformation of the maternal–fetal relationship into the mother–infant relationship remains an enigmatic process. This progression is considered using a Research Domain Criteria (RDoC) informed approach centered on domains of Arousal/Regulation, Positive/Negative Valence, and Social Processes. One hundred and fifty-eight maternal–fetal dyads began participation during pregnancy, maternal–infant dyads were followed at 6 months postpartum. Women exhibited stability in feelings of attachment to the fetus and infant, and in positive/negative appraisal of pregnancy and motherhood. Elicited maternal physiological arousal to emotionally evocative videos generated fetal heart rate variability and motor activity responses. Parasympathetic (i.e., heart rate variability) suppression in the fetus was associated with more positive and regulated infant social communication in the Face-to-Face Still Face protocol; suppression of maternal respiratory sinus arrhythmia was related to infant affect but in the opposite direction. Maternal ratings of infant temperament aligned with maternal antenatal affective valence. Attachment trajectories characterized by stability from antenatal to postnatal periods were most associated with maternal affective appraisal of pregnancy; shifts were influenced by infant characteristics and maternal sympathetic responsivity. Results illustrate how variation in arousal and regulatory systems of the pregnant woman and fetus operate within the context of maternal positive and negative valence systems to separately and jointly shape affiliation and temperament in early infancy.
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16
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Bowers K, Ding L, Yolton K, Ji H, Nidey N, Meyer J, Ammerman RT, Van Ginkel J, Folger A. Pregnancy and Infant Development (PRIDE)-a preliminary observational study of maternal adversity and infant development. BMC Pediatr 2021; 21:452. [PMID: 34649513 PMCID: PMC8518281 DOI: 10.1186/s12887-021-02801-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 06/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Children from socioeconomically disadvantaged families have a markedly elevated risk for impaired cognitive and social-emotional development. Children in poverty experience have a high risk for developmental delays. Poverty engenders disproportionate exposure to psychological adversity which may contribute to impaired offspring development; however the effect may be mitigated by social support and other aspects of resilience. Our objective was to determine the association between maternal stress, adversity and social support and early infant neurobehavior and child behavior at two and three years. Methods We conducted a longitudinal mother-infant cohort study nested within a regional home visiting program in Cincinnati, Ohio. Four home study visits were completed to collect measures of maternal stress, adversity and social support and infant and child behavior. A measure of infant neurobehavior (‘high-arousal’ infant) was derived from the NICU Network Neurobehavioral Scale (NNNS) at 1 month and externalizing and internalizing symptoms were measured by the Child Behavior Checklist (CBCL) at 24 and 36 months. Linear and logistic regression identified associations between maternal risk/protective factors and infant and child behavioral measures. We used stratification and multiplicative interaction terms to examine potential interactions. Results We enrolled n = 55 pregnant mothers and follow 53 mother–offspring dyads at 1 month, 40 dyads at 24 months and 27 dyads at 36 months. Maternal adversity and protective factors were not associated with neurobehavior at one month. However, maternal depression and measures of distress in pregnancy were significantly associated with internalizing and externalizing symptoms at 24 and 36 months. Conclusions This pilot study established the feasibility of conducting longitudinal research within a community intervention program. In addition, although there were no statistically significant associations between maternal psychosocial factors in pregnancy and infant neurobehavior, there were several associations at 24 months, primarily internalizing symptoms, which persisted through 36 months. Future work will replicate findings within a larger study as well as explore mediators and modifiers of these associations.
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Affiliation(s)
- Katherine Bowers
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA. .,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Lili Ding
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kimberly Yolton
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hong Ji
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Asthma Research, Pyrosequencing Core Lab for Epigenomic and Genomic Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Anatomy, Physiology and Cell biology California National Primate Research Center School of Veterinary Medicine, University of California, Davis, CA, 95616, USA
| | - Nichole Nidey
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jerrold Meyer
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Neuroscience and Behavior Program, Amherst, MA, USA
| | - Robert T Ammerman
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Every Child Succeeds, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Judith Van Ginkel
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Every Child Succeeds, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alonzo Folger
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Every Child Succeeds, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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17
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Alves AC, Cecatti JG, Souza RT. Resilience and Stress during Pregnancy: A Comprehensive Multidimensional Approach in Maternal and Perinatal Health. ScientificWorldJournal 2021; 2021:9512854. [PMID: 34434079 PMCID: PMC8382548 DOI: 10.1155/2021/9512854] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022] Open
Abstract
This narrative review addresses resilience and stress during pregnancy, which is part of a broader concept of maternal health. Pregnancy and postpartum are opportune periods for health promotion interventions, especially because the close contact of the women with health professionals. In this way, it can be considered a useful window of opportunity to identify women at higher risk for adverse outcomes. Integrated health is a concept that aims at providing comprehensive care related to the promotion of individuals' physical, mental, and social well-being. In this context, stress during pregnancy has been targeted as a remarkable condition to be addressed whether due to individual issues, social issues, or specific pregnancy issues, since it is directly and indirectly associated with pregnancy complications. Stress is associated with preterm birth, postpartum depression, anxiety, child neurodevelopment, and fetal distress. The way that an individual faces a stressful and adverse situation is called resilience; this reaction is individual, dynamic, and contextual, and it can affect maternal and fetal outcomes. Low resilience has been associated with poorer pregnancy outcomes. The social context of pregnancy can act as a protective or contributory (risk) factor, indicating that environments of high social vulnerability play a negative role in resilience and, consequently, in perceived stress. A given stressor can be enhanced or mitigated depending on the social context that was imposed, as well as it can be interpreted as different degrees of perceived stress and faced with a higher or lower degree of resilience. Understanding these complex mechanisms may be valuable for tackling this matter. Therefore, in the pregnancy-puerperal period, the analysis of the stress-resilience relationship is essential, especially in contexts of greater social vulnerability, and is a health-promoting factor for both the mother and baby.
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Affiliation(s)
- A. C. Alves
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - J. G. Cecatti
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - R. T. Souza
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
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18
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Mood during pregnancy: Trends, structure, and invariance by gestational day. J Psychiatr Res 2021; 140:260-266. [PMID: 34119911 DOI: 10.1016/j.jpsychires.2021.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/12/2021] [Accepted: 06/04/2021] [Indexed: 11/24/2022]
Abstract
Mood dynamics during pregnancy are important in understanding a critical period of human development, and also as a model for biopsychosocial stress processes. Here, in four large samples of smartphone app respondents (differentiated by time period and number of responses), we modeled mood for each gestational day during the pregnancy period. We aimed to delineate patterns of changes in mood across pregnancy, as well as potential changes in measurement properties across the period. Results indicated that three prominent mood factors - positivity, distress, and irritability - could account for responses in this period, and that changes in measurement properties of mood items across pregnancy were small in magnitude. Mean irritability increased, and positivity decreased, in the first trimester before reversing in direction; there was also some evidence for previously reported U-shaped trends in mood, where negative mood is greatest early in pregnancy, decreases, and then increases again. Results help characterize mood processes at a detailed level during a critical period, and point to directions for future research to explicate causes and effects of mood changes during this time.
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19
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Varga S, Mackert M, Mandell DJ. The prenatal triad: The importance of provider-patient communication with expectant fathers throughout the prenatal care process. PATIENT EDUCATION AND COUNSELING 2021; 104:1826-1830. [PMID: 33229190 DOI: 10.1016/j.pec.2020.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/14/2020] [Accepted: 11/03/2020] [Indexed: 06/11/2023]
Abstract
Previous research has primarily focused on the relationship between providers and expectant mothers as a key element of quality prenatal care. Significantly less attention has been directed toward expectant fathers and the importance of their communication with prenatal care providers and involvement in the prenatal care process. Much of this limited existing literature emphasizes the health benefits including fathers would bring for mom and baby, but rarely is the potential benefit to fathers' health included in the conversation. This discussion aims to highlight the value of this line of research for both communication and medical researchers and consider potential avenues for studying and promoting father engagement in prenatal care.
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Affiliation(s)
- Sarah Varga
- Department of Communication Studies, Moody College of Communication, The University of Texas at Austin, Austin, USA.
| | - Michael Mackert
- Center for Health Communication, Stan Richards School of Advertising & Public Relations, and Department of Population Health, The University of Texas at Austin, Austin, USA
| | - Dorothy J Mandell
- School of Community and Rural Health, The University of Texas Health Science Center at Tyler, and Population Health University of Texas, System Administration, Austin, USA
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20
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Guo Y, Kehoe P, Pimentel P, Rousseau J, Axelin A, Rahmani AM, Dutt N. Exercise and Stress in At-Risk Women during Pregnancy and Postpartum. MCN Am J Matern Child Nurs 2021; 46:217-222. [PMID: 34166239 DOI: 10.1097/nmc.0000000000000722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE We aimed to understand the relationship between exercise and stress among socioeconomically at-risk women who participated in a home visitation service during pregnancy and postpartum. METHODS A mixed-methods design was used to support and supplement quantitative data using qualitative data. Convenience sampling was used to collect data from at-risk women via questionnaires and follow-up interviews. The Perceived Stress Scale was used to assess stress. Frequency and duration of exercise were assessed based on the American College of Obstetricians and Gynecologists exercise guidelines. Regression analyses examined the association between stress and exercise controlling for covariates. Content analysis was used to understand women's stress management experiences. RESULTS N = 114 women completed the questionnaire and a subgroup of 11 received follow-up interviews. Greater frequency of exercise was significantly associated with lower levels of stress. Approximately one-third of women reported experiencing significant stress. Talking to their husband or partner was the most used and exercise was the least used coping strategy. Many women recognized the importance of managing stress and benefits of exercise, but were hindered by barriers such as feeling tired, preventing them from exercising. CLINICAL IMPLICATIONS A personalized and safe exercise program has the potential to be a low-cost stress management strategy for women during pregnancy and postpartum.
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21
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Doaltabadi Z, Amiri-Farahani L, Hasanpoor-Azghady SB, Haghani S. The effect of face-to-face and virtual prenatal care training of spouses on the pregnancy experience and fear of childbirth of primiparous women: A controlled quasi-experimental study. J Telemed Telecare 2021; 29:1357633X211024101. [PMID: 34160307 DOI: 10.1177/1357633x211024101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The spouse has a special role in promoting the health of mothers and infants during pregnancy, childbirth, and postpartum. Women's health during pregnancy requires the participation and cooperation of their spouses. Therefore, this study was conducted to determine the effect of face-to-face and virtual prenatal care training of spouses on the pregnancy experience and fear of childbirth of primiparous women. METHODS This is a quasi-experimental clinical trial that was conducted on primiparous pregnant women referring to three prenatal clinics in Tehran, Iran. Sampling was done by available method and pregnant women were divided into three groups of face-to-face training (n = 35), virtual training (n = 35), and control (n = 33). The content of training program in the virtual and face-to-face groups was similar and included; nutrition during pregnancy, emotional support, fetal growth and development, advantages and disadvantages of vaginal delivery, planning for delivery, infant care, and danger signs for infants, which were presented in four sessions. The samples in the control group did not receive any training. In the 18th and 20th weeks of pregnancy, the demographic information form, pregnancy experience scale, and version A of the Wijma delivery expectancy/experience questionnaires were completed, and once again in the 37th and 38th weeks of pregnancy, the pregnancy experience scale and version A of the Wijma delivery expectancy/experience questionnaires were completed. RESULTS There was a statistically significant difference in the mean score of pregnancy experience after the intervention between the face-to-face training and control groups (p = 0.001). There was a statistically significant difference in the mean score of uplifts between the two groups of face-to-face training and control (p = 0.01), and also between virtual training and control groups (p = 0.02). There was a statistically significant difference between the two groups of face-to-face training and control in terms of and hassles score after the intervention (p = 0.04). There was a statistically significant difference between the two groups of face-to-face training and control (p = 0.02) and also between virtual training and control (p = 0.04) in terms of the mean score of fear of childbirth after the intervention. CONCLUSION The results of this study showed that teaching prenatal care to spouses of primiparous women by face-to-face and virtual methods can be a useful intervention in improving the pregnancy experience and reducing the fear of childbirth among primiparous women.
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Affiliation(s)
- Zari Doaltabadi
- Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Leila Amiri-Farahani
- Department of Reproductive Health and Midwifery, Nursing Care Research Center, School of Nursing and Midwifery, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Batool Hasanpoor-Azghady
- Department of Reproductive Health and Midwifery, Nursing Care Research Center, School of Nursing and Midwifery, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Shima Haghani
- Department of Biostatistics, Nursing Care Research Center, 440827Iran University of Medical Sciences, Tehran, Iran
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22
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Aiello EM, Deshpande S, Ozaslan B, Wolkowicz KL, Dassau E, Pinsker JE, Doyle FJ. Review of Automated Insulin Delivery Systems for Individuals with Type 1 Diabetes: Tailored Solutions for Subpopulations. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2021; 19. [PMID: 34368518 DOI: 10.1016/j.cobme.2021.100312] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Automated insulin delivery (AID) systems have proven safe and effective in improving glycemic outcomes in individuals with type 1 diabetes (T1D). Clinical evaluation of this technology has progressed to large randomized, controlled outpatient studies and recent commercial approval of AID systems for children and adults. However, several challenges remain in improving these systems for different subpopulations (e.g., young children, athletes, pregnant women, seniors and those with hypoglycemia unawareness). In this review, we highlight the requirements and challenges in AID design for selected subpopulations, and discuss current advances from recent clinical studies.
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Affiliation(s)
- Eleonora M Aiello
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 150 Western Avenue, Boston, Massachusetts 02134, USA.,Sansum Diabetes Research Institute, Santa Barbara, CA
| | - Sunil Deshpande
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 150 Western Avenue, Boston, Massachusetts 02134, USA.,Sansum Diabetes Research Institute, Santa Barbara, CA
| | - Basak Ozaslan
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 150 Western Avenue, Boston, Massachusetts 02134, USA.,Sansum Diabetes Research Institute, Santa Barbara, CA
| | - Kelilah L Wolkowicz
- Department of Mechanical Engineering, University of Massachusetts Lowell, 1 University Avenue, Lowell, MA 01854, USA
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 150 Western Avenue, Boston, Massachusetts 02134, USA.,Sansum Diabetes Research Institute, Santa Barbara, CA
| | | | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 150 Western Avenue, Boston, Massachusetts 02134, USA.,Sansum Diabetes Research Institute, Santa Barbara, CA
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Samuel P, Yew RY, Hooley M, Hickey M, Stokes MA. Sensory challenges experienced by autistic women during pregnancy and childbirth: a systematic review. Arch Gynecol Obstet 2021; 305:299-311. [PMID: 34085111 DOI: 10.1007/s00404-021-06109-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this systematic review was to identify challenges faced by autistic women during pregnancy and birth due to sensory issues or other features of Autism Spectrum Disorder. METHODS A systematic search of literature was conducted using Medline, PubMed, Embase, PsycINFO, CINAHL, MIDIRS, ProQuest Dissertations and Theses Global, and Open Access Theses and Dissertations. Eligible studies addressed autistic women's pregnancy or birth experiences, and were assessed for methodological quality. RESULTS The search generated 2656 results, with six meeting inclusion criteria. Data from 427 autistic participants were extracted from four qualitative and two quantitative studies for synthesis. CONCLUSION We found that the literature was exploratory and lacked focussed research questions addressing sensory issues in pregnancy. Sensory challenges were, however, identified as a key finding in all qualitative studies. Other challenges faced by autistic women during pregnancy and birth included communication issues in healthcare settings and lack of appropriate information and supports for pregnancy and birth. Implications for health professionals and challenges associated with research in this area are discussed.
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Affiliation(s)
- Priscilla Samuel
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap St., Geelong, VIC, 3220, Australia
| | - Rui Ying Yew
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap St., Geelong, VIC, 3220, Australia
| | - Merrilyn Hooley
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap St., Geelong, VIC, 3220, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
| | - Mark A Stokes
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap St., Geelong, VIC, 3220, Australia. .,School of Psychology, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
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van Dijk W, Oosterman M, Jansen I, de Vente W, Huizink A. Stress- and smoke free pregnancy study protocol: a randomized controlled trial of a personalized eHealth intervention including heart rate variability-biofeedback to support pregnant women quit smoking via stress reduction. BMC Public Health 2021; 21:905. [PMID: 33980201 PMCID: PMC8115871 DOI: 10.1186/s12889-021-10910-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 04/26/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Maternal smoking and stress during pregnancy are associated with adverse health effects for women themselves and are risk factors for adverse developmental outcomes of the unborn child. Smoking and stress seem to be intertwined in various ways. First, the majority of smoking pregnant women is of lower socio-economic status, which is associated with higher levels of perceived stress. Second, smoking women often report to smoke because they feel stressed. Third, quitting smoking often increases perceived stress levels initially. Therefore, effective interventions are needed to support women with smoking cessation by reducing stress. The aim of this study is to test the effectiveness of an eHealth intervention on stress reduction and smoking cessation. METHODS/DESIGN The Stress- and Smoke Free Start of Life (SSFSL) study is a randomized controlled trial (RCT) comparing a personalized eHealth intervention with a control condition. Inclusion criteria for the women are: (1) > 18 years of age, (2) < 28 weeks pregnant at recruitment, (3) currently smoking. Consenting participants will be randomly assigned to the intervention or control group. Participants allocated to the intervention group will receive an 8-week intervention delivered on their smartphone. The application includes psycho-education on pregnancy, stress, and smoking (cessation); stress-management training consisting of Heart Rate Variability-biofeedback; and a personalized stop-smoking-plan. Participants in the control condition will be invited to visit a webpage with information on pregnancy, stress, and smoking (cessation). Study outcomes will be collected via online questionnaires, at four timepoints: pre-intervention (baseline; t0), post-intervention (8 weeks + 1 day after t0; t1), follow up at two weeks after birth (t2), and follow up at three months after birth (t3). The primary outcome measure is self-reported smoking cessation. Secondary outcomes include daily self-reported number of cigarettes smoked, perceived stress, pregnancy experience, birth outcomes, and negative affectivity scores of the baby. Moreover, the mediating effect of stress reduction on smoking cessation will be examined, and possible moderators will be tested. DISCUSSION If the eHealth intervention is effective in smoking cessation among pregnant smoking women, it can be implemented as a tool into the health care in the Netherlands. TRIAL REGISTRATION Netherlands Trial Register, ID: NL8156 . Registered on 11 November 2019.
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Affiliation(s)
- Willeke van Dijk
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands.
| | - Mirjam Oosterman
- Department of Clinical Child and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Imke Jansen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
| | - Wieke de Vente
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands
| | - Anja Huizink
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
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Chapuis-de-Andrade S, Moret-Tatay C, Quarti Irigaray T, Breno Costa D, Antonello ICF, Pinheiro da Costa BE. Coping with stress and personality: A study in pregnancies complicated by hypertension. Clin Psychol Psychother 2021; 28:1607-1619. [PMID: 33899979 DOI: 10.1002/cpp.2603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this work is to investigate the role of personality in pregnancies complicated by hypertension, thru analysis of structure and associations between negative affect and coping strategies, and their role towards psychological distress. METHOD A cross-sectional study with 343 women, where 192 pregnancies complicated by hypertension, was carried out by employing the following tools: the five-factor model (Big Five), Depression, Anxiety and Stress Scale (DASS-21), and Jalowiec's Coping Inventory. Two complementary strategies were carried out: an exploratory approach on the interactions between latent variables and a confirmatory technique. RESULTS Coping strategies seem to be dissociated in the hypertensive group, and these participants tend to use strategies according to their personality, mostly emotion focused, extraversion, and neuroticism. The extraversion model exclusively shows an acceptable goodness-of-fit after a structural equation modelling. A multigroup analysis reached a full metric invariance level for extraversion. CONCLUSIONS These results are of interest for both clinical and research settings. Prenatal screening and associated interventions may reduce perinatal negative affective states and related pregnancy complications.
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Affiliation(s)
- Sabrina Chapuis-de-Andrade
- Postgraduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.,Department of Public Health, Federal Institute of Education, Science and Technology of Rio Grande do Sul (IFRS), Alvorada, Brazil
| | - Carmen Moret-Tatay
- MEB laboratory, Faculty of Psychology, Universidad Católica de Valencia San Vicente Mártir (UCV), Valencia, Spain
| | - Tatiana Quarti Irigaray
- Postgraduate Program in Psychology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Dalton Breno Costa
- Department of Psychology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Ivan Carlos Ferreira Antonello
- Postgraduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Bartira Ercília Pinheiro da Costa
- Postgraduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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Doaltabadi Z, Amiri-Farahani L, Hasanpoor-Azghady SB. Implementation of Virtual and Face-to-Face Childbirth Preparation Training for the Spouses of the Primiparous Women to Reduce the Fear of Childbirth, Improve the Pregnancy Experience, and Enhance Mother- and Father-Infant Attachment: Protocol for a Quasiexperimental Clinical Trial. Obstet Gynecol Int 2021; 2021:6686934. [PMID: 33936209 PMCID: PMC8055428 DOI: 10.1155/2021/6686934] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/18/2021] [Accepted: 04/01/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Men have a special role to play in promoting maternal and child health during pregnancy, childbirth, and postpartum period. The health of women also requires the participation and cooperation of men. The aim of this study is to compare the effect of virtual and face-to-face childbirth preparation training for spouses of the primiparous women on the pregnancy experience, fear of childbirth (FOC), and mother- and father-infant attachment. METHODS The primiparous women attending the prenatal clinics of Lolagar Hospital and Azadi and Tehransar health centers of Tehran along with their husbands will be studied. The inclusion criteria for the women's husbands are the first experience of becoming a father, being at least 18 years of age, and the ability to read and write. The exclusion criteria for women's husbands are the history of physical/mental illness; being a smoker; and consuming alcohol, drugs, or psychotropic substances. The participants will be selected by the convenience sampling method and will be divided into three groups of study A, study B, and control. Spouses in study groups A and B will receive childbirth training through virtual and face-to-face methods with similar content, respectively. The control group only receives ordinary prenatal care. At the 18-20 weeks of gestation, demographic information, pregnancy experience scale (PES), and version A of Wijma delivery expectancy/experience questionnaire (WDEQ-A) will be completed. At 37-38 weeks of gestation, the PES and WDEQ-A questionnaires will be completed again and maternal postnatal attachment scale (MPAS) and postnatal paternal-infant attachment questionnaire (PPAQ) will be completed by the parents 12 weeks after the delivery. Discussion. Improving the experience of pregnancy, especially reducing the FOC and creating a positive attitude towards it, is a vital strategy to promote vaginal childbirth and reduce the number of cesarean sections requested by women. Achieving this will reduce the cost of health care and improve the quality of life during pregnancy, after childbirth, and during the growth and development of infants. Ethics and Dissemination. This research has been funded by the Iran University of Medical Sciences, approved by the Thailand Registry of Clinical Trials, and will commence in May 2020. Results will be disseminated through peer-reviewed journals and shared with the academic and medical community to pregnancy and childbirth outcomes. This trial is registered with TCTR20200515011.
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Affiliation(s)
- Zari Doaltabadi
- Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Amiri-Farahani
- Department of Reproductive Health and Midwifery, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Batool Hasanpoor-Azghady
- Department of Reproductive Health and Midwifery, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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Mahrer NE, Guardino CM, Hobel C, Dunkel Schetter C. Maternal Stress Before Conception Is Associated with Shorter Gestation. Ann Behav Med 2021; 55:242-252. [PMID: 32686836 PMCID: PMC7980768 DOI: 10.1093/abm/kaaa047] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Stress in pregnancy predicts adverse birth outcomes. Stressors occurring prior to conception may also pose risk for the mother and child. The few published studies on preconception stress test a single stress measure and examine only linear associations with birth outcomes. PURPOSE Guided by findings in the prenatal stress literature, the current study aimed to (i) identify latent factors from a set of preconception stress measures and (ii) examine linear and curvilinear associations between these stress factors and length of gestation. METHODS Study 1 utilized a sample of 2,637 racially/ethnically diverse women to develop a measurement model of maternal stress from assessments of seven acute and chronic stress measures. Factor analysis revealed three latent factors representing stressors (life events, financial strain, interpersonal violence, discrimination), stress appraisals (perceived stress, parenting stress), and chronic relationship stress (family, partner stress). Study 2 examined the associations of these three latent preconception stress factors with the length of gestation of a subsequent pregnancy in the subset of 360 women who became pregnant within 4.5 years. RESULTS Controlling for prenatal medical risks, there was a significant linear effect of stress appraisals on the length of gestation such that more perceived stress was associated with shorter gestation. There was a curvilinear effect of stressors on the length of gestation with moderate levels associated with longer gestation. CONCLUSIONS These results have implications for research on intergenerational origins of developmental adversities and may guide preconception prevention efforts. Findings also inform approaches to the study of stress as a multidimensional construct.
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Affiliation(s)
- N E Mahrer
- Department of Psychology, University of California, Los Angeles, CA, USA
- Psychology Department, University of La Verne, CA, USA
| | - C M Guardino
- Department of Psychology, Dickinson College, PA, USA
| | - C Hobel
- Department of Obstetrics and Gynecology, Cedars-Sinai, CA, USA
| | - C Dunkel Schetter
- Department of Psychology, University of California, Los Angeles, CA, USA
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28
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Probiotics as a treatment for prenatal maternal anxiety and depression: a double-blind randomized pilot trial. Sci Rep 2021; 11:3051. [PMID: 33542275 PMCID: PMC7862351 DOI: 10.1038/s41598-021-81204-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/23/2020] [Indexed: 02/07/2023] Open
Abstract
Probiotic use may be an efficacious treatment option to effectively manage symptoms of prenatal maternal anxiety and depression. Our primary aim was to test feasibility and acceptability for a probiotic randomized controlled trial (RCT) in pregnant women with pre-existing symptoms. This double-blind pilot RCT included 40 pregnant women with low-risk pregnancies and elevated depressive symptoms and/or anxiety. Once daily, participants orally consumed a probiotic (Ecologic Barrier) or a placebo, from 26 to 30 weeks gestation until delivery. A priori key progression criteria for primary outcomes were determined to decide whether or not a full RCT was feasible and acceptable. Secondary outcomes included depressive symptoms, anxiety, stress, and maternal bonding to offspring. In 19 months, 1573 women were screened; following screening, 155 women (10%) were invited for participation, of whom 135 (87%) received study information, and 40 women (30%) were included. Four out of six a priori determined criteria for success on feasibility and acceptability were met. After 8 weeks of intervention, there was no significant difference between the probiotic and placebo groups for secondary outcomes. The pilot trial was feasible and acceptable, but hampered by recruitment method and study design. Secondary endpoints did not reveal differences between the groups for improving maternal mood.
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29
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Verner G, Epel E, Lahti-Pulkkinen M, Kajantie E, Buss C, Lin J, Blackburn E, Räikkönen K, Wadhwa PD, Entringer S. Maternal Psychological Resilience During Pregnancy and Newborn Telomere Length: A Prospective Study. Am J Psychiatry 2021; 178:183-192. [PMID: 32911996 PMCID: PMC7855094 DOI: 10.1176/appi.ajp.2020.19101003] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE In the context of the importance of elucidating the determinants of the initial, newborn setting of telomere length (TL), it is increasingly evident that maternal stress and stress-related processes during pregnancy play a major role. Although psychological resilience may function as a buffer, research in this area has not yet examined its potential role vis-à-vis that of stress. The authors examined the relationship between maternal psychological resilience during pregnancy and newborn TL. METHODS In a sample of 656 mother-child dyads from the Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction cohort, multiple serial assessments were conducted over the course of pregnancy to quantify maternal stress, negative and positive emotional responses to pregnancy events, positive affect, and perceived social support. Principal component analysis identified two latent factors: stress and positivity. A measure of resilience was computed by regressing the positivity factor on the stress factor, in order to quantify positivity after accounting for stress. TL was measured using quantitative polymerase chain reaction in leukocytes extracted from cord blood shortly after birth. Linear regression was used to predict newborn TL from maternal resilience during pregnancy, adjusting for other potential determinants. RESULTS Maternal stress significantly predicted shorter newborn TL (β=-0.079), and positivity significantly predicted longer TL (β=0.135). Maternal resilience (positivity accounting for stress) was significantly and positively associated with newborn TL (β=0.114, 95% CI=0.035, 0.189), with each standard deviation increase in resilience predicting 12% longer newborn TL. CONCLUSIONS The results indicate that maternal psychological resilience may exert a salubrious effect on offspring telomere biology and highlight the importance of enhancing maternal mental health and well-being during pregnancy.
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Affiliation(s)
- Glenn Verner
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, Berlin, Germany
| | - Elissa Epel
- Department of Psychiatry, San Francisco School of Medicine, University of California, San Francisco, California, USA
| | | | - Eero Kajantie
- Department of Public Health Solutions, THL National Institute for Health and Welfare, Helsinki and Oulu, Finland,PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway,Children’s Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Claudia Buss
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, Berlin, Germany,Department of Pediatrics, University of California, Irvine, Irvine, California,UC Irvine Development, Health and Disease Research Program, University of California, Irvine, Irvine, California
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
| | - Elizabeth Blackburn
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA,Department of Microbiology and Immunology, University of California, San Francisco, California, USA
| | - Katri Räikkönen
- Department of Psychology and Logopedics, University of Helsinki, Finland
| | - Pathik D. Wadhwa
- Department of Pediatrics, University of California, Irvine, Irvine, California,UC Irvine Development, Health and Disease Research Program, University of California, Irvine, Irvine, California,Department of Psychiatry & Human Behavior, University of California, Irvine, School of Medicine, Irvine, California, USA,Department of Obstetrics & Gynecology, University of California, Irvine, School of Medicine, Irvine, California, USA,Department of Epidemiology, University of California, Irvine, School of Medicine, Irvine, California, USA
| | - Sonja Entringer
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, Berlin, Germany,Department of Pediatrics, University of California, Irvine, Irvine, California,UC Irvine Development, Health and Disease Research Program, University of California, Irvine, Irvine, California
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Khalife‐Ghaderi F, Amiri‐Farahani L, Haghani S, Hasanpoor‐Azghady SB. Examining the experience of childbirth and its predictors among women who have recently given birth. Nurs Open 2021; 8:63-71. [PMID: 33318813 PMCID: PMC7729799 DOI: 10.1002/nop2.603] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 07/03/2020] [Accepted: 07/23/2020] [Indexed: 11/25/2022] Open
Abstract
Aims The aim of this study is to examine the experience of childbirth and its predictors among women who have recently given birth. Design This is a cross-sectional study. Methods This study was conducted on 225 women at 22 Bahman Hospital in Khaf City, Iran. The samples were selected by the continuous sampling method from August to November 2018. Data were collected by demographic questionnaire, fertility information, pregnancy experience scale, satisfaction from birth environment inventory and the childbirth experience questionnaire. Results The mean score of childbirth experience was 55.73. According to the regression model, the husband's education, receiving regular care during pregnancy, the person giving birth, presence of a companion, receiving spinal anaesthesia, perineal conditions, being uplifted and hassled about the pregnancy and satisfaction with the birth environment were the predictors of childbirth experience. The regression model showed 39.8% of the change in outcome variable was predicted by independent variables.
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Affiliation(s)
- Faeze Khalife‐Ghaderi
- Department of Reproductive Health and MidwiferySchool of Nursing and MidwiferyIran University of Medical SciencesTehranIran
| | - Leila Amiri‐Farahani
- Department of Reproductive Health and MidwiferyNursing Care Research CenterSchool of Nursing and MidwiferyIran University of Medical SciencesTehranIran
| | - Shima Haghani
- Department of BiostatisticsNursing Care Research CenterIran University of Medical SciencesTehranIran
| | - Syedeh Batool Hasanpoor‐Azghady
- Department of Reproductive Health and MidwiferyNursing Care Research CenterSchool of Nursing and MidwiferyIran University of Medical SciencesTehranIran
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Romero-Gonzalez B, Martin CR, Caparros-Gonzalez RA, Quesada-Soto JM, Peralta-Ramirez MI. Spanish validation and factor structure of the Prenatal Distress Questionnaire Revised (NuPDQ). J Reprod Infant Psychol 2020; 40:242-253. [PMID: 33327777 DOI: 10.1080/02646838.2020.1861227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Due to an absence of maternal stress being measured in routine prenatal care by clinicians, prenatal stress has become a serious problem which is associated with poorer obstetric outcomes, as well as worse maternal and infant health. For that reason, the aim of this study was the translation, validation and adaptation of Prenatal Distress Questionnaire Revised (NuPDQ) in a Spanish sample.Methods: Three-hundred and seventy-one pregnant women were assessed using the NuPDQ, the Prenatal Distress Questionnaire, Perceived Stress Scale and the Connor-Davidson Resilience Scale. The NuPDQ was translated into Spanish by the backtranslation method and administered to participants.Results: A confirmatory factor analysis revealed the established unidimensional structure to be a poor fit to data with the Spanish version. An exploratory factor analysis suggested a five-factor structure with 14 items. The instrument had good reliability, convergent and discriminant validity psychometric properties.Conclusions: The five-factor 14-item NuPDQ is useful to assess pregnancy-specific stress in Spanish pregnant women. It may be appropriate to use this instrument in order to identify pregnant women with high pregnancy-specific stress to try to prevent negative consequences derived from those high levels.
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Affiliation(s)
- Borja Romero-Gonzalez
- Department of Personality, Assessment and Psychological Treatment, University of Granada, Granada, Spain.,Brain, Mind and Behavior Research Center (CIMCYC), Faculty of Psychology, University of Granada, Granada, Spain
| | - Colin R Martin
- Faculty of Health Sciences, University of Hull, Hull, UK
| | | | - Juan M Quesada-Soto
- Brain, Mind and Behavior Research Center (CIMCYC), Faculty of Psychology, University of Granada, Granada, Spain
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Fitzgerald E, Hor K, Drake AJ. Maternal influences on fetal brain development: The role of nutrition, infection and stress, and the potential for intergenerational consequences. Early Hum Dev 2020; 150:105190. [PMID: 32948364 PMCID: PMC7481314 DOI: 10.1016/j.earlhumdev.2020.105190] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
An optimal early life environment is crucial for ensuring ideal neurodevelopmental outcomes. Brain development consists of a finely tuned series of spatially and temporally constrained events, which may be affected by exposure to a sub-optimal intra-uterine environment. Evidence suggests brain development may be particularly vulnerable to factors such as maternal nutrition, infection and stress during pregnancy. In this review, we discuss how maternal factors such as these can affect brain development and outcome in offspring, and we also identify evidence which suggests that the outcome can, in many cases, be stratified by socio-economic status (SES), with individuals in lower brackets typically having a worse outcome. We consider the relevant epidemiological evidence and draw parallels to mechanisms suggested by preclinical work where appropriate. We also discuss possible transgenerational effects of these maternal factors and the potential mechanisms involved. We conclude that modifiable factors such as maternal nutrition, infection and stress are important contributors to atypical brain development and that SES also likely has a key role.
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Affiliation(s)
- Eamon Fitzgerald
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Kahyee Hor
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Amanda J Drake
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.
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Loyal D, Sutter AL, Rascle N. Screening Beyond Postpartum Depression: Occluded Anxiety Component in the EPDS (EPDS-3A) in French Mothers. Matern Child Health J 2020; 24:369-377. [PMID: 31974900 DOI: 10.1007/s10995-020-02885-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION According to many studies, anxiety in the perinatal period is widespread and has many detrimental effects. Thus, screening measures should not be limited to assessing depression symptoms. The widely used Edinburgh Postnatal Depression Scale (EPDS) might assess depression but also anxiety symptoms. This study explores whether an anxiety dimension (EPDS-3A) was found and valid in French women during pregnancy and the postpartum period. METHODS French women were followed-up at late pregnancy and 2 and 4 months postpartum (N = 144, 138 and 129). They completed the EPDS and the Hospital Anxiety and Depression Scale (HADS-A). Exploratory factor analyses were performed. Then to test its validity, the EPDS-3A was correlated with anxiety (HADS-A) and depression (EPDS-D) scores. Finally, prevalence estimates were computed according to recommended cut off. RESULTS The anxiety dimension assessed through the EPDS-3A was observed during the postpartum period but not during pregnancy. A two-factor structure (depression and anxiety) increases the variance explained at 2 and 4 months postpartum (respectively 6 and 12%). The EPDS-3A shows good internal consistency (≥ .70) and was more strongly associated with anxiety scores (HADS-A) (.48-.57) than with depression scores (EPDS-D) (.30-.39). Nearly 28% of mothers had scores that exceeded the EPDS-3A cut off (≥ 4) but not the full EPDS cut off (≥ 13 or more). DISCUSSION The EPDS contains an anxiety component (EPDS-3A) that can be found in French women during the postnatal period but not during pregnancy. It shows signs of internal consistency and validity. The EPDS-3A could be considered when screening for postpartum anxiety.
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Affiliation(s)
- D Loyal
- Univ. Bordeaux, Bordeaux Population Health, 146 rue Léo Saignat, 33076, Bordeaux, France.
| | - A-L Sutter
- Univ. Bordeaux, Bordeaux Population Health, 146 rue Léo Saignat, 33076, Bordeaux, France
- Charles Perrens Hôpital, 121 Rue de la Béchade, 33076, Bordeaux, France
| | - N Rascle
- Univ. Bordeaux, Bordeaux Population Health, 146 rue Léo Saignat, 33076, Bordeaux, France
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VOEGTLINE KM, JOHNSON SB, HUANG RB, DIPIETRO JA. The bloom is (slightly) off the rose: the motherhood effect on psychological functioning in successive pregnancies. J Psychosom Obstet Gynaecol 2020; 41:177-182. [PMID: 31466499 PMCID: PMC7048633 DOI: 10.1080/0167482x.2019.1657089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Objective: To examine the maternal psychological state during the course of two successive pregnancies.Methods: The sample consisted of 73 women drawn from a larger maternal-fetal cohort that participated during two pregnancies. Women completed self-report psychological questionnaires at 24, 30, and 36 weeks gestation to index maternal depressive symptoms, trait anxiety, and pregnancy hassles and uplifts. Analyses examined stability of maternal symptoms across successive pregnancies in the same women.Results: Antenatal symptoms of depression and anxiety exhibited strong intra-individual stability between successive pregnancies. Mean differences in maternal symptoms were not detected for either at 24, 30, or 36 weeks gestation, excepting elevated anxiety symptoms at the mid-point due to greater fluctuation in maternal anxiety during the prior pregnancy. Subsequent pregnancies were associated with less intense uplifting feelings about the pregnancy on each measurement occasion.Conclusions: Findings suggest marked consistency in maternal psychological orientation across subsequent pregnancies, though parity also plays a role in the maternal experience.
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Affiliation(s)
| | - Sara B. JOHNSON
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Ruthe B. HUANG
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Janet A. DIPIETRO
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Matvienko-Sikar K, Cooney J, Flannery C, Murphy J, Khashan A, Huizink A. Maternal stress in the first 1000 days and risk of childhood obesity: a systematic review. J Reprod Infant Psychol 2020; 39:180-204. [PMID: 32046507 DOI: 10.1080/02646838.2020.1724917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective: Maternal stress is associated with adverse child outcomes. Conception to 2-years postpartum (the first 1000 days) is a developmentally sensitive period for stress exposure. The role of maternal stress in the first 1000 days on child obesity risk is unclear. This review systematically examines the relationship between maternal stress across the first 1000 days and child obesity risk. Methods: The Cochrane Library, MEDLINE, PsycINFO, EMBASE, CINAHL, and Maternity and Infant Care were searched from inception to June 2018. Eligible studies included women who experienced maternal stress in the first 1000 days; an included a measure of maternal stress and of child anthropometrics. Results: Sixteen studies met inclusion criteria, the majority of these examined prenatal stress exposure. Inconsistent effects were observed for psychological and physiological stress responses, on child weight outcomes. Environmental stress exposures, including natural disaster and bereavement, were more consistently associated with increased obesity risk. Conclusion: This review does not provide support for the effects of psychological or physiological maternal stress on child weight outcomes; there is some evidence of associations between environmental stress exposures and greater childhood adiposity. Variation in conceptualisation and measurement of stress, timing of stress exposure, and limited examination of stress-related behaviours were noted.
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Affiliation(s)
| | - Jennifer Cooney
- School of Applied Psychology, University College Cork , Cork, Ireland
| | - Caragh Flannery
- School of Public Health, University College Cork , Cork, Ireland
| | - Jennifer Murphy
- School of Public Health, University College Cork , Cork, Ireland
| | - Ali Khashan
- School of Public Health, University College Cork , Cork, Ireland.,Irish Centre for Fetal and Neonatal Transnational Research (INFANT) Centre, Cork University Maternity Hospital , Cork, Ireland
| | - Anja Huizink
- Department of Clinical, Neuro- and Developmental Psychology, VU University Amsterdam , Amsterdam, The Netherlands
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Campbell RK, Tamayo-Ortiz M, Cantoral A, Schnaas L, Osorio-Valencia E, Wright RJ, Téllez-Rojo MM, Wright RO. Maternal Prenatal Psychosocial Stress and Prepregnancy BMI Associations with Fetal Iron Status. Curr Dev Nutr 2020; 4:nzaa018. [PMID: 32099952 PMCID: PMC7026381 DOI: 10.1093/cdn/nzaa018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/30/2020] [Accepted: 02/04/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Iron accrued in utero is critical for fetal and infant neurocognitive development. Psychosocial stress and obesity can each suppress fetal iron accrual. Their combined effects and differences by fetal sex are not known. In an observational pregnancy cohort study in Mexico City, we investigated associations of maternal prenatal life stressors, psychological dysfunction, and prepregnancy BMI with fetal iron status at delivery. OBJECTIVES We hypothesized that greater maternal prenatal psychosocial stress and prepregnancy overweight and obesity are associated with lower cord blood ferritin and hemoglobin (Hb), with stronger associations in boys than girls. METHODS Psychosocial stress in multiple domains of life stress (negative life events, perceived stress, exposure to violence) and psychological dysfunction symptoms (depression, generalized anxiety, and pregnancy-specific anxiety) were assessed with validated questionnaires during pregnancy. Prepregnancy BMI was predicted with a validated equation and categorized as normal/overweight/obese. Cord blood ferritin and Hb associations with prenatal psychosocial stress and BMI were modeled in multivariable linear regressions adjusted for maternal age, socioeconomic status, child sex, and prenatal iron supplementation. Interactions with child sex and 3-way stress-overweight/obesity-sex interactions were tested with product terms and likelihood ratio tests. RESULTS In 493 dyads, median (IQR) cord blood ferritin and Hb concentrations were 185 µg/L (126-263 g/dL) and 16 g/dL (14.7-17.1 g/dL), respectively. Ferritin was lower in infants of mothers with higher prenatal perceived stress (-23%; 95% CI: -35%, -9%), violence exposure (-28%; 95% CI: -42%, -12%), anxiety symptoms (-16%; 95% CI: -27%, -4%), and obesity (-17%; 95% CI: -31%, 0.2%). Interaction models suggested sex differences and synergism between maternal stress and overweight/obesity. No associations were observed between stress or BMI and Hb. CONCLUSIONS Multiple prenatal psychosocial stressors and excess prepregnancy BMI were each inversely associated with fetal iron status at birth. Pregnancies and infants at elevated risk of impaired fetal iron accrual may be identifiable according to observed synergism between maternal stress and obesity and differential associations with fetal iron status by infant sex.
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Affiliation(s)
- Rebecca K Campbell
- Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marcela Tamayo-Ortiz
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
- National Council for Science and Technology, Mexico City, Mexico
| | - Alejandra Cantoral
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
- National Council for Science and Technology, Mexico City, Mexico
| | - Lourdes Schnaas
- Division of Research in Community Interventions, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Erika Osorio-Valencia
- Division of Research in Community Interventions, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Rosalind J Wright
- Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Martha M Téllez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Robert O Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Beijers R, Hartman S, Shalev I, Hastings W, Mattern BC, de Weerth C, Belsky J. Testing three hypotheses about effects of sensitive-insensitive parenting on telomeres. Dev Psychol 2020; 56:237-250. [PMID: 31961192 PMCID: PMC7391860 DOI: 10.1037/dev0000879] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Telomeres are the protective DNA-protein sequences appearing at the ends of chromosomes; they shorten with each cell division and are considered a biomarker of aging. Shorter telomere length and greater erosion have been associated with compromised physical and mental health and are hypothesized to be affected by early life stress. In the latter case, most work has relied on retrospective measures of early life stressors. The Dutch research (n = 193) presented herein tested 3 hypotheses prospectively regarding effects of sensitive-insensitive parenting during the first 2.5 years on telomere length at age 6, when first measured, and change over the following 4 years. It was predicted that (1) less sensitive parenting would predict shorter telomeres and greater erosion and that such effects would be most pronounced in children (2) exposed to prenatal stress and/or (3) who were highly negatively emotional as infants. Results revealed, only, that prenatal stress amplified parenting effects on telomere change-in a differential-susceptibility-related manner: Prenatally stressed children displayed more erosion when they experienced insensitive parenting and less erosion when they experienced sensitive parenting. Mechanisms that might initiate greater postnatal plasticity as a result of prenatal stress are highlighted and future work outlined. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | - Jay Belsky
- Department of Human Development and Family Studies
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Ferreira L, Marini G, Amaral AL, Santos TCD, Conti MHSD. Translation, cultural adaptation and validation of "Pregnancy Experience Scale" for Brazilian pregnant. FISIOTERAPIA EM MOVIMENTO 2020. [DOI: 10.1590/1980-5918.033.ao01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Abstract Introduction: The analysis of maternal psychosocial stress during pregnancy can be an important intervention tool for maternal and infant health. Objective: To translate, culturally adapt and validate the Pregnancy Experience Scale - Brief Version - into Brazilian Portuguese for Brazilian pregnant women. Method: The scale was carried out according to the guidelines recommended by Beaton and his collaborators. Data were collected between January and September of 2016, in hospitals, basic health units, and community. In total, 206 pregnant women with an average age of 25.01 ± 6.44 years and gestational age of 25.5 ± 8.72 pregnancy weeks answered the scale for the process of psychometric analysis and validation. Results: The results indicated a two-dimensional model of the scale with two factors: Positive Experiences and Negative Experiences. The reliability was established through Cronbach’s Alpha Test (α > 0.70). The value found for the positive experiences factor was appropriate, α = 0.77. The same happened to the Negative Experiences factor, α = 0.80. These values provide evidence of the scale reliability. The convergent and concurrent validity of the instrument was established. Conclusion: The result of the psychometric study of the scale pointed out that the Pregnancy Experience Scale is an important intervention tool for the health care of mother and newborn, besides being a useful instrument to assess the experience of the women with the pregnancy, especially, the level of psychosocial stress, contributing to broaden the research in this area and subsidize support strategies for this population and women’s health policies.
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Göbel A, Arck P, Hecher K, Schulte-Markwort M, Diemert A, Mudra S. Manifestation and Associated Factors of Pregnancy-Related Worries in Expectant Fathers. Front Psychiatry 2020; 11:575845. [PMID: 33362598 PMCID: PMC7759496 DOI: 10.3389/fpsyt.2020.575845] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022] Open
Abstract
Background: During the last decades, fathers have increasingly participated in prenatal care, birth preparation classes, and childbirth. However, comparably little is known about the prenatal emotional well-being of fathers, particularly content and extent of broader paternal concerns that may arise during pregnancy beyond those focusing on childbirth. Thus, the aims of this study were to investigate the manifestation of paternal pregnancy-related worries in a population-based sample and to identify relevant associated factors. Materials and Methods: As part of a longitudinal pregnancy cohort at the University Medical Center Hamburg-Eppendorf, Germany, N = 129 expectant fathers were assessed once during pregnancy. Pregnancy-related worries centering around medical procedures, childbirth, health of the baby, as well as socioeconomic aspects were assessed with the Cambridge Worry Scale (CWS). Additionally, paternal socioeconomic background and maternal obstetrical history, symptoms of generalized anxiety and depression, and level of hostility were investigated, as well as perceived social support. The cross-sectional data were analyzed based on multiple regression analyses. Results: The level of reported worries was overall low. Some fathers reported major worries for individual aspects like the health of a significant other (10.9%) and the baby (10.1%), as well as the current financial (6.2%) and employment situation (8.5%). Pregnancy-related worries were negatively associated with household income and positively associated with anxious and depressive symptoms and low perceived social support. Associations varied for specific pregnancy-related worries. Limitations: Due to the cross-sectional data examined in this study, a causal interpretation of the results is not possible. The sample was rather homogeneous regarding its socioeconomic background. More research needs to be done in larger, more heterogeneous samples. Conclusion: Though overall worries were rather low in this sample, specific major worries could be identified. Hence, addressing those fathers reporting major worries regarding specific aspects already in prenatal care might support their psychosocial adjustment. Fathers with little income, those with elevated levels of general anxious and depressive symptoms, and those with less social support reported higher pregnancy-related worries. Our results indicate the relevance of concerns beyond health- and birth-related aspects that could be relevant for fathers. Measurements developed specifically for expectant fathers are needed to properly capture their perspective already during pregnancy.
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Affiliation(s)
- Ariane Göbel
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petra Arck
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Schulte-Markwort
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anke Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Mudra
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Walsh K, McCormack CA, Webster R, Pinto A, Lee S, Feng T, Krakovsky HS, O'Grady SM, Tycko B, Champagne FA, Werner EA, Liu G, Monk C. Maternal prenatal stress phenotypes associate with fetal neurodevelopment and birth outcomes. Proc Natl Acad Sci U S A 2019; 116:23996-24005. [PMID: 31611411 PMCID: PMC6883837 DOI: 10.1073/pnas.1905890116] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Maternal prenatal stress influences offspring neurodevelopment and birth outcomes including the ratio of males to females born; however, there is limited understanding of what types of stress matter, and for whom. Using a data-driven approach with 27 variables from questionnaires, ambulatory diaries, and physical assessments collected early in the singleton pregnancies of 187 women, 3 latent profiles of maternal prenatal stress emerged that were differentially associated with sex at birth, birth outcomes, and fetal neurodevelopment. Most women (66.8%) were in the healthy group (HG); 17.1% were in the psychologically stressed group (PSYG), evidencing clinically meaningful elevations in perceived stress, depression, and anxiety; and 16% were in the physically stressed group (PHSG) with relatively higher ambulatory blood pressure and increased caloric intake. The population normative male:female secondary sex ratio (105:100) was lower in the PSYG (2:3) and PHSG (4:9), and higher in the HG (23:18), consistent with research showing diminished male births in maternal stress contexts. PHSG versus HG infants were born 1.5 wk earlier (P < 0.05) with 22% compared to 5% born preterm. PHSG versus HG fetuses had decreased fetal heart rate-movement coupling (P < 0.05), which may indicate slower central nervous system development, and PSYG versus PHSG fetuses had more birth complications, consistent with previous findings among offspring of women with psychiatric illness. Social support most strongly differentiated the HG, PSYG, and PHSG groups, and higher social support was associated with increased odds of male versus female births. Stress phenotypes in pregnant women are associated with male vulnerability and poor fetal outcomes.
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Affiliation(s)
- Kate Walsh
- Ferkauf Graduate School of Psychology, Yeshiva University, The Bronx, NY 10461
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032
| | - Clare A McCormack
- Center for Science and Society, Columbia University, New York, NY 10027
| | - Rachel Webster
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032
| | - Anita Pinto
- Data Science, Columbia University, New York, NY 10027
| | - Seonjoo Lee
- Division of Behavioral Medicine, New York State Psychiatric Institute, New York, NY 10032
- Department of Biostatistics (in Psychiatry), Mailman School of Public Health, Columbia University, New York, NY 10032
| | - Tianshu Feng
- Department of Biostatistics (in Psychiatry), Mailman School of Public Health, Columbia University, New York, NY 10032
| | - H Sloan Krakovsky
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032
| | - Sinclaire M O'Grady
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032
| | - Benjamin Tycko
- Hackensack-Meridian Health Center for Discovery and Innovation, Nutley, NJ 07110
| | - Frances A Champagne
- Department of Psychiatry, Columbia University, New York, NY 10032
- Department of Psychology, University of Texas at Austin, Austin, TX 78712
| | - Elizabeth A Werner
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032
- Department of Psychiatry, Columbia University, New York, NY 10032
| | - Grace Liu
- Department of Psychiatry, Columbia University, New York, NY 10032
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032;
- Division of Behavioral Medicine, New York State Psychiatric Institute, New York, NY 10032
- Department of Psychiatry, Columbia University, New York, NY 10032
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Simons SSH, Zijlmans MAC, Cillessen AHN, de Weerth C. Maternal prenatal and early postnatal distress and child stress responses at age 6. Stress 2019; 22:654-663. [PMID: 31092104 DOI: 10.1080/10253890.2019.1608945] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Individuals differ in their physiological and behavioral stress responses. Alterations in these responses have been associated with mental and physical health. Therefore, it is important to understand how stress responses develop. This study investigated whether in a healthy, non-risk population, 6-year-old's physiological (cortisol) and behavioral (gazing) stress responses were associated with stress early in the child's life, in the form of maternal prenatal and early postnatal distress. Additionally, associations between the two stress responses were studied. At age 6, children (n = 149; Mage = 6.09; 70 girls) in a longitudinal project that started prenatally (n = 193), participated in a social evaluative stress test (Children's Reactions to Evaluation Stress Test, CREST) in front of a judge. To operationalize physiological stress responses six cortisol saliva samples were collected and cortisol stress reactivity and total stress cortisol scores were calculated. To operationalize behavioral stress responses, gazing at the judge during the stress test was observed. Maternal prenatal distress (week 37) was measured using questionnaires and physiological measures, that is, cortisol saliva samples. Early postnatal maternal distress (first 6 months) was measured using questionnaires. Results of hierarchical regression analyses indicated that less maternal prenatal fear of giving birth, higher maternal prenatal evening cortisol concentrations, and more maternal feelings of anxiety in the first 6 postnatal months were all uniquely associated with higher total stress cortisol concentrations in children at age 6. Additionally, correlations indicated that children with higher cortisol stress reactivity gazed less in the direction of the judge. Results indicate that maternal prenatal and early postnatal distress are associated with children's later hypothalamic-pituitary-adrenal-axis functioning and that in children gazing and physiological stress reactivity are related. Lay summary We examined whether maternal stress and anxiety during pregnancy, as measured by means of maternal self-reports and saliva cortisol samples, as well as maternal stress and anxiety in the first 6 months of the child's life, measured using maternal self-reports, were associated with children's physiological (cortisol) and behavioral (gazing) responses during a stressful laboratory situation at the age of 6. Results showed that mothers with higher levels of distress in late pregnancy and/or the early postnatal period had children with higher cortisol concentrations during the stressful situation. This suggests that maternal prenatal and early postnatal distress are associated with children's later hypothalamic-pituitary-adrenal-axis functioning.
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Affiliation(s)
- Sterre S H Simons
- Behavioural Science Institute, Radboud University , Nijmegen , The Netherlands
| | | | | | - Carolina de Weerth
- Behavioural Science Institute, Radboud University , Nijmegen , The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center , Nijmegen , The Netherlands
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Matthey S, Souter K, Valenti B, Ross-Hamid C. Validation of the MGMQ in screening for emotional difficulties in women during pregnancy. J Affect Disord 2019; 256:156-163. [PMID: 31176188 DOI: 10.1016/j.jad.2019.05.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/12/2019] [Accepted: 05/22/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Screening for emotional health difficulties in pregnant or postpartum women is becoming routine practice in health services. This screening is often done using the EPDS, usually using a screen positive score just to identify possible depression. This and other such scales often have a myriad of screen-positive scores, making them impractical within clinical settings. The recent MGMQ screens for a variety of negative moods, is brief, simple, and has just a few screen-positive thresholds. METHOD At recruitment 391 women attending routine antenatal clinics completed various mood questionnaires. Several weeks later they were re-contacted by phone, at which time 247-252 of them provided valid data on the MGMQ, EPDS, and a diagnostic interview for depression and anxiety disorders (numbers vary depending upon valid combinations). RESULTS The MGMQ showed good-excellent receiver operating characteristics (sensitivity specificity, positive predictive value) against diagnostic status for depression or anxiety disorders. It also showed good concurrent and concordant validity with the EPDS, and good discriminant validity between women with clinical and subclinical diagnostic caseness. Stability over several weeks was however low, indicating that, as with other measures, women's mood can naturally change during the perinatal period. LIMITATIONS The findings only apply to English-speaking antenatal women from Sydney, Australia. CONCLUSION The MGMQ has good psychometric properties when compared to the usual gold-standard applied to emotional health screening measures. Its brevity, simplicity to 'score' and interpret, together with its clinically useful questions, suggest it could be a practical alternative to other more complicated mood screening measures for perinatal women.
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Affiliation(s)
- Stephen Matthey
- School of Psychology, University of Sydney, Sydney Australia; South Western Sydney Local Health District, Sydney Australia.
| | - Kay Souter
- South Western Sydney Local Health District, Sydney Australia
| | | | - Clodah Ross-Hamid
- School of Psychology, University of Western Sydney, Sydney Australia
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Rotem-Kohavi N, Williams LJ, Muller AM, Abdi H, Virji-Babul N, Bjornson BH, Brain U, Werker JF, Grunau RE, Miller SP, Oberlander TF. Hub distribution of the brain functional networks of newborns prenatally exposed to maternal depression and SSRI antidepressants. Depress Anxiety 2019; 36:753-765. [PMID: 31066992 DOI: 10.1002/da.22906] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/07/2019] [Accepted: 04/10/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Prenatal maternal depression (PMD) and selective serotonin reuptake inhibitor (SSRI) antidepressants are associated with increased developmental risk in infants. Reports suggest that PMD is associated with hyperconnectivity of the insula and the amygdala, while SSRI exposure is associated with hyperconnectivity of the auditory network in the infant brain. However, associations between functional brain organization and PMD and/or SSRI exposure are not well understood. METHODS We examined the relation between PMD or SSRI exposure and neonatal brain functional organization. Infants of control (n = 17), depressed SSRI-treated (n = 20) and depressed-only (HAM-D ≥ 8) (n = 16) women, underwent resting-state functional magnetic resonance imaging at postnatal Day 6. At 6 months, temperament was assessed using Infant Behavioral Questionnaire (IBQ). We applied GTA and partial least square regression (PLSR) to the resting-state time series to assess group differences in modularity, and connector and provincial hubs. RESULTS Modularity was similar across all groups. The depressed-only group showed higher connector hub values in the left anterior cingulate, insula, and caudate as well as higher provincial hub values in the amygdala compared to the control group. The SSRI group showed higher provincial hub values in Heschl's gyrus relative to the depressed-only group. PLSR showed that newborns' hub values predicted 10% of the variability in infant temperament at 6 months, suggesting different developmental patterns between groups. CONCLUSIONS Prenatal exposures to maternal depression and SSRIs have differential impacts on neonatal functional brain organization. Hub values at 6 days predict variance in temperament between infant groups at 6 months of age.
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Affiliation(s)
- Naama Rotem-Kohavi
- Graduate Program in Neuroscience, School of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lynne J Williams
- BC Children Hospital MRI Research Facility, Vancouver, BC, Canada
| | - Angela M Muller
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Hervé Abdi
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, Texas
| | - Naznin Virji-Babul
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Bruce H Bjornson
- Brain Mapping, Neuroinformatics and Neurotechnology Laboratory, Division of Neurology, British Columbia Children's Hospital, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada.,BC Children Hospital MRI Research Facility, Vancouver, BC, Canada
| | - Ursula Brain
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Janet F Werker
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Ruth E Grunau
- BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Steven P Miller
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, Canada
| | - Tim F Oberlander
- BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Krusche A, Crane C, Dymond M. An investigation of dispositional mindfulness and mood during pregnancy. BMC Pregnancy Childbirth 2019; 19:273. [PMID: 31370814 PMCID: PMC6676599 DOI: 10.1186/s12884-019-2416-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/19/2019] [Indexed: 01/06/2023] Open
Abstract
Background Mindfulness courses are being offered to numerous groups and while a large body of research has investigated links between dispositional mindfulness and mood, few studies have reported this relationship during pregnancy. The aim of this study was to investigate this relationship in pregnant women to offer insight into whether an intervention which may plausibly increase dispositional mindfulness would be beneficial for this population. Methods A cross-sectional analysis was conducted to explore potential relationships between measures of mindfulness and general and pregnancy-specific mood. A sample of pregnant women (n = 363) was recruited using online advertising and community-based recruitment and asked to complete a number of questionnaires online. Results Overall, higher levels of mindfulness were associated with improved levels of general and pregnancy-related mood in pregnant women. Controlling for general stress and anxiety, higher scores for mindfulness in (psychologically) healthy women were associated with lower levels of pregnancy-related depression, distress and labour worry but this relationship was not apparent in those with current mental health problems. In participants without children, higher mindfulness levels were related to lower levels of pregnancy-related distress. Conclusions These results suggest a promising relationship between dispositional mindfulness and mood though it varies depending on background and current problems. More research is needed, but this paper represents a first step in examining the potential of mindfulness courses for pregnant women. Increasing mindfulness, and therefore completing mindfulness-based courses, is potentially beneficial for improvements in mood during pregnancy. Electronic supplementary material The online version of this article (10.1186/s12884-019-2416-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adele Krusche
- University of Oxford, Oxford, UK. .,Psychology Department, University of Southampton, Shackleton Building Room 3045, Highfield Campus, University Road, Southampton, Hampshire, SO17 1BJ, UK.
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Probiotics in pregnancy: protocol of a double-blind randomized controlled pilot trial for pregnant women with depression and anxiety (PIP pilot trial). Trials 2019; 20:440. [PMID: 31315657 PMCID: PMC6637581 DOI: 10.1186/s13063-019-3389-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 05/02/2019] [Indexed: 12/28/2022] Open
Abstract
Background Maternal prenatal depressive or anxiety symptoms are associated with adverse maternal and infant health outcomes. With prevalence rates of maternal prenatal depression and anxiety ranging between 10 and 20%, attempts to identify effective interventions to reduce symptoms are priority. There are indications that probiotics can reduce symptoms of maternal depression or anxiety. Probiotics ingested by the mother may thus offer a promising and accessible intervention to complement existing treatments. Methods The Probiotics in Pregnancy (PIP) pilot trial is a double-blind, placebo-controlled, randomized pilot trial. While one group orally consumes a probiotic mixture (Ecologic® Barrier; 2,5 × 109 colony forming units/g; 2 g; daily), the other group consumes a placebo, from between 26 and 30 weeks gestation until delivery. Subjects are randomly allocated (1:1) to the intervention or placebo group. Forty healthy pregnant women with symptoms of depression or anxiety and uncomplicated pregnancies at randomization will be included. The primary aim is to determine the feasibility and acceptability of a probiotic trial to reduce symptoms of maternal depression or anxiety in pregnancy. The secondary aim is to exploratorily compare the potential effect of probiotics, compared to placebo, on depressive and/or anxiety symptoms, maternal stress (i.e. reported/hair cortisol), maternal vaginal and intestinal microbiota, and by possibly affecting maternal mood and microbiota, maternal bonding to offspring, infant microbiota and infant crying. Discussion Results of this pilot trial will help determine whether or not to proceed with a full trial after the pilot trial, and if so, whether revisions should be made to the study protocol and procedures before conducting a full randomized controlled trial. Additionally, they are expected to provide insights into whether changes in psychological, behavioral and biological parameters can be attributed to the probiotic intervention. Trial registration Netherlands Trial Register, NTR6219. Registered on 28 February 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3389-1) contains supplementary material, which is available to authorized users.
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Dere SS, Varotariya JK, Ghildiyal RP, Sharma SA, Kaur DMS. Antenatal preparedness for motherhood and its association with antenatal anxiety and depression in first time pregnant women from India. Ind Psychiatry J 2019; 28:255-261. [PMID: 33223720 PMCID: PMC7659993 DOI: 10.4103/ipj.ipj_66_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 04/26/2020] [Accepted: 06/04/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIMS Pregnancy is a developmental period demanding special adjustments. Psychologically, pregnancy can be associated with positive preparedness in some and fear of childbirth or doubts of mothering role in others. Anxiety and depression during pregnancy can have negative implications on its outcome. The current study aims to provide insight into factors influencing maternal preparedness for motherhood. METHODOLOGY Hundred first time pregnant women were enrolled after written informed consent and ethical approval. The Pregnancy Experiences Scale-Brief Version was used to study maternal rating of uplifts and hassles experiences specific to pregnancy, indicating affective valence toward the pregnancy. Pregnancy-Related Anxiety Questionnaire (PRAQ-R) helped to identify pregnancy-specific anxiety and depressive symptoms were screened using Whooley's Questions. Data were analyzed using Microsoft Excel 15.30 (170107). RESULTS The mean age of the women was 23.1 years. More than half of the pregnancies were unplanned, and the mean duration of pregnancy was 6.8 months. The positive experience was reported more than a negative experience. Negative valence increased in the presence of psychosocial stressors. On PRAQ-R, anxiety symptoms were reported by 52% of the patients, especially high on the domain of "fear of giving birth" and increased with trimester. Depressive symptoms were reported by 23% of the women. CONCLUSION Advanced gestation, presence of stressors, past psychiatric illness, ANC complications, and the presence of anxiety/depression influence maternal preparedness for motherhood. There is a need of sensitizing the doctors, nurses, health-care workers, and relatives regarding screening, referral of unmet psychological needs of pregnant women to help new mothers to adjust with their motherhood positively.
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Affiliation(s)
| | - Jagdish K Varotariya
- Department of Psychiatry, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India
| | - Rakesh P Ghildiyal
- Department of Psychiatry, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India
| | - Sunil A Sharma
- Department of Obstetrics and Gynaecology, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India
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Conceptualization, measurement, and effects of pregnancy-specific stress: review of research using the original and revised Prenatal Distress Questionnaire. J Behav Med 2019; 43:16-33. [PMID: 31183596 DOI: 10.1007/s10865-019-00068-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 06/04/2019] [Indexed: 12/26/2022]
Abstract
Pregnancy-specific stress (PSS) arises from the numerous changes that women experience during pregnancy and from their concerns about childbirth and the health of their offspring. Prolonged or elevated maternal stress heightens risk for poor fetal, infant, and child outcomes. The Prenatal Distress Questionnaire (PDQ) and its expanded successor, the revised Prenatal Distress Questionnaire (NuPDQ), were developed to assess PSS, but their psychometric properties and findings are not well-documented. We reviewed research using the PDQ (n = 45) or NuPDQ (n = 37). Results establish that PSS as measured by these instruments is common in pregnancy; PSS is associated with sociodemographic and obstetric characteristics, perceptions of pregnancy, health behaviors, maternal health, and birth outcomes. The NuPDQ is an especially appropriate tool to assess PSS, with demonstrated reliability and convergent, concurrent, and predictive validity. The ability to assess PSS in a reliable and valid manner is critical to advance research and improve maternal and child health.
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Hechler C, Borewicz K, Beijers R, Saccenti E, Riksen-Walraven M, Smidt H, de Weerth C. Association between Psychosocial Stress and Fecal Microbiota in Pregnant Women. Sci Rep 2019; 9:4463. [PMID: 30872645 PMCID: PMC6418257 DOI: 10.1038/s41598-019-40434-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 02/07/2019] [Indexed: 12/26/2022] Open
Abstract
Maternal prenatal psychosocial stress is associated with altered child emotional and behavioral development. One potential underlying mechanism is that prenatal psychosocial stress affects child outcomes via the mother's, and in turn the child's, intestinal microbiota. This study investigates the first step of this mechanism: the relation between psychosocial stress and fecal microbiota in pregnant mothers. Mothers (N = 70) provided a late pregnancy stool sample and filled in questionnaires on general and pregnancy-specific stress and anxiety. Bacterial DNA was extracted and analysed by Illumina HiSeq sequencing of PCR-amplified 16 S ribosomal RNA gene fragments. Associations between maternal general anxiety and microbial composition were found. No associations between the other measured psychosocial stress variables and the relative abundance of microbial groups were detected. This study shows associations between maternal pregnancy general anxiety and microbial composition, providing first evidence of a mechanism through which psychological symptoms in pregnancy may affect the offspring.
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Affiliation(s)
- C Hechler
- Behavioral Science Institute, Radboud University Nijmegen, Montessorilaan 3, 6525 HR, Nijmegen, The Netherlands.
| | - K Borewicz
- Laboratory of Microbiology, Wageningen University & Research, Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - R Beijers
- Behavioral Science Institute, Radboud University Nijmegen, Montessorilaan 3, 6525 HR, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Kapittelweg 29, 6525 EN, Nijmegen, The Netherlands
| | - E Saccenti
- Laboratory of Systems and Synthetic Biology, Wageningen University & Research, Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - M Riksen-Walraven
- Behavioral Science Institute, Radboud University Nijmegen, Montessorilaan 3, 6525 HR, Nijmegen, The Netherlands
| | - H Smidt
- Laboratory of Microbiology, Wageningen University & Research, Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - C de Weerth
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Kapittelweg 29, 6525 EN, Nijmegen, The Netherlands
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Matthey S, Souter K. Is pregnancy-specific anxiety more enduring than general anxiety using self-report measures? A short-term longitudinal study. J Reprod Infant Psychol 2019; 37:384-396. [PMID: 30806080 DOI: 10.1080/02646838.2019.1578869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To investigate whether the rates of transient and enduring distress differ between general and pregnancy-specific anxiety in antenatal English-speaking women. Background: Evidence indicates that half of women with high levels of general anxiety during pregnancy will no longer be highly anxious after a few weeks, without having received treatment. Pregnancy-specific anxiety, however, may be more enduring, as many worries concerning the forthcoming birth, whether the baby will be healthy and the woman's ability to care for a newborn are likely to continue, or increase, during the pregnancy. Method: Women attending a public hospital antenatal clinic completed several mood questionnaires, including a mix of general anxiety and pregnancy-specific anxiety scales (T1). Between 2 and weeks later (T2), still during pregnancy, participants completed the same measures via a phone interview. Results: Between 76 and 243 women completed the different measures at both time points. For each measure the result was similar: about half of women scoring high at the first assessment (T1) continued to score high at T2 on both the general and pregnancy-specific anxiety measures, despite not receiving any specialist intervention. By contrast, over 90% of women initially scoring low on the various measures continued to score low at T2. Conclusion: Whether women are screened for pregnancy-specific or for general anxiety, around half scoring 'high' on the measure will no longer be in the anxious range a few weeks later. They thus have 'transient' anxiety. This transient/enduring finding was also confirmed for those with high levels of depressive symptomatology.
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Affiliation(s)
- Stephen Matthey
- a School of Psychology, University of Sydney , Sydney , Australia.,b School of Psychiatry, UNSW , Sydney , Australia.,c South West Sydney Local Health District , Sydney , Australia
| | - Kay Souter
- c South West Sydney Local Health District , Sydney , Australia
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Ibrahim SM, Nicoloro-SantaBarbara J, Auerbach MV, Rosenthal L, Kocis C, Busso CE, Lobel M. Pregnancy-specific coping and changes in emotional distress from mid- to late pregnancy. J Reprod Infant Psychol 2019; 37:397-412. [PMID: 30773900 DOI: 10.1080/02646838.2019.1578871] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To examine whether pregnancy-specific coping predicts changes in emotional distress from mid- to late pregnancy. Background: There is a need to identify ways of coping that reduce or elevate emotional distress in pregnant women as such distress increases the risk of adverse birth outcomes. Methods: 132 women receiving prenatal care from a university hospital midwifery practice were recruited prior to 25 weeks gestation (M = 19.58, SD = 5.14). The state anxiety version of the State-Trait Personality Inventory (STPI) and the Revised Prenatal Distress Questionnaire (NuPDQ) were administered in mid- (M = 25.7 weeks, SD = 4.55) and late (M = 33.4 weeks, SD = 4.18) pregnancy and the Revised Prenatal Coping Inventory (NuPCI) at the latter timepoint. Results: Factor analysis of the NuPCI identified five distinct, conceptually interpretable types of coping: Prayer/Spirituality, Receiving Social Support, Planning/Preparation, Positive Appraisal, and Avoidant Coping. Avoidant Coping was used least frequently and Positive Appraisal was used most. The STPI and NuPDQ were aggregated to create a measure of emotional distress. After controlling for mid-pregnancy distress, Avoidant Coping predicted greater emotional distress in late pregnancy (β = .18, R2 = .61, p < .01) and Positive Appraisal predicted lower late pregnancy distress (β = -.15, R2 = .60, p < .01). Conclusion: This is one of the first studies to demonstrate that specific ways of coping with stress during pregnancy predict changes in pregnant women's emotional distress. The NuPCI is a psychometrically sound self-report instrument to examine coping and its association with emotional distress.
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Affiliation(s)
- Sirena M Ibrahim
- a Department of Psychology, Stony Brook University , Stony Brook , NY , USA
| | | | | | - Lisa Rosenthal
- c Department of Psychology, Pace University , New York , NY , USA
| | - Christina Kocis
- d School of Medicine, Stony Brook University , Stony Brook , NY , USA
| | - Cheyanne E Busso
- a Department of Psychology, Stony Brook University , Stony Brook , NY , USA
| | - Marci Lobel
- a Department of Psychology, Stony Brook University , Stony Brook , NY , USA
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