The pregnancy experience scale-brief version

Feasibility and acceptability of measuring prenatal stress in daily life using smartphone-based ecological momentary assessment and wearable physiological monitors

High levels of stress during pregnancy can have lasting effects on maternal and offspring health, which disproportionately impacts families facing financial strain, systemic racism, and other forms of social oppression. Developing ways to monitor daily life stress during pregnancy is important for reducing stress-related health disparities. We evaluated the feasibility and acceptability of using mobile health (mHealth) technology (i.e., wearable biosensors, smartphone-based ecological momentary assessment) to measure prenatal stress in daily life. Fifty pregnant women (67% receiving public assistance; 70% Black, 6% Multiracial, 24% White) completed 10 days of ambulatory assessment, in which they answered smartphone-based surveys six times a day and wore a chest-band device (movisens EcgMove4) to monitor their heart rate, heart rate variability, and activity level. Feasibility and acceptability were evaluated using behavioral meta-data and participant feedback. Findings supported the feasibility and acceptability of mHealth methods: Participants answered approximately 75% of the surveys per day and wore the device for approximately 10 hours per day. Perceived burden was low. Notably, participants with higher reported stressors and financial strain reported lower burden associated with the protocol than participants with fewer life stressors, highlighting the feasibility of mHealth technology for monitoring prenatal stress among pregnant populations living with higher levels of contextual stressors. Findings support the use of mHealth technology to measure prenatal stress in real-world, daily life settings, which shows promise for informing scalable, technology-assisted interventions that may help to reduce health disparities by enabling more accessible and comprehensive care during pregnancy.

Stress-related eating in pregnancy? An RCT examining links between prenatal stress and food choices

BACKGROUND

Diet quality during pregnancy is important for maternal health and offspring development. However, national dietary recommendations are not always met. A potential barrier for healthy food choices might be the experience of stress. Previous literature in non-pregnant populations suggests a negative effect of acute stress on diet quality. This preregistered study is the first to test whether an acute stressor leads to unhealthy food choices in pregnancy and examine the moderating role of stress, depressive and anxiety complaints in daily life.

METHOD

Pregnant women (N = 110, 3rd trimester) completed online self-reported surveys measuring stress, depressive and anxiety complaints in daily life. Hereafter, participants were invited for a laboratory visit, in which they were exposed to the Trier Social Stress Test or a control task. After this manipulation, self-reported and actual food choices and food intake were assessed. At the end of the visit, a hair sample was collected. Throughout the visit, visual analogue scales on negative affect were completed and saliva samples were collected.

RESULTS

The stress group experienced significantly more psychological stress than the control group during the experimental manipulation. Main regression analyses showed that the acute laboratory stressor did not cause unhealthy food choices in the third trimester of pregnancy. In fact, the stress group chose fewer unhealthy foods and consumed fewer kilocalories compared to the control group. Additionally, the findings point at a moderating role of depressive and stress complaints in daily life on food choices within the control group: higher scores were related to more unhealthy food choices and more kilocalories consumed.

DISCUSSION

As this was the first study to test the effect of an acute stressor on food choices in pregnant women, more research is needed to obtain a better understanding of stress-related eating in pregnancy. This knowledge may inform future interventions to support pregnant women in improving their diet quality.

The prevalence of unintended pregnancy and its influence on pregnancy experience in Tabriz, Iran, 2023: a cross-sectional study

BACKGROUND

There is a lack of quantitative studies that specifically measure the association between the experience of pregnancy and unintended pregnancy. The present study aims to address the prevalence of unintended pregnancy and identify its predictors. Additionally, the study explores whether unintended pregnancy is associated with pregnancy uplifts and hassles.

METHODS

This cross-sectional study was conducted on 488 pregnant women between 20 to 40 weeks' gestation at the comprehensive health center in Tabriz City from February 2022 to January 2023. A cluster sampling method was used for sampling, and data were collected using socio-demographic questionnaires and the Pregnancy Experience Scale (PES). Descriptive statistics were used to describe the socio-demographic characteristics and the prevalence of unintended pregnancy. Binary logistic regression was employed to identify the predictors of pregnancy desirability. To examine the relationship between unintended pregnancy and pregnancy experience, an independent t-test was used for bivariate analysis, and a general linear model (GLM) was utilized for multivariate analysis, with control for potential confounding variables.

RESULTS

The prevalence of unintended pregnancies was 30.7% (24.3% unwanted pregnancies, and 6.4% mistimed pregnancies). The results of the binary logistic regression indicated that the lower age of both the woman and her spouse were significant predictors for unintended pregnancy (P < 0.05). Based on an independent t-test, the mean score for uplifts in women with unintended pregnancy was significantly lower than in women with intended pregnancy (mean difference (MD): -4.99; 95% confidence interval (CI): -5.96 to -4.02; p < 0.001), While the mean score of hassles in women with unintended pregnancy was significantly higher than women with intended pregnancy (MD: 2.92; 95% CI: 2.03 to 3.80; p < 0.001). The results of GLM showed that women who had unintended pregnancies had significantly lower scores for uplifts (B = -4.99; 95% CI: -5.96 to -4.03; P < 0.001) and higher scores for hassles (B = 2.92; 95% CI: 2.06 to 3.78; P < 0.001).

CONCLUSIONS

The high prevalence of unintended pregnancies in Tabriz highlights the importance of targeted interventions to address this issue, considering the policy framework and unique challenges faced by women. Future studies should focus on developing context-specific interventions that effectively meet the needs of women with unintended pregnancies.

Implementation and evaluation of the centering pregnancy group prenatal care model in pregnant women with diabetes: a convergent parallel mixed methods study protocol

BACKGROUND

Diabetes during pregnancy has negative effects on both mothers and their fetuses. To improve perinatal outcomes and women's experience of care, the World Health Organization (WHO) suggests implementing health system interventions to enhance the use and quality of antenatal care. The main goal of this study is to implement and evaluate the outcomes of the Centering Pregnancy group care model for pregnant women with diabetes.

METHODS/DESIGN

The study will consist of three phases: a quantitative phase, a qualitative phase, and a mixed phase. In the quantitative phase, a randomized controlled trial will be conducted on 100 pregnant women with diabetes receiving prenatal care in Tabriz City, Iran. The Summary of Diabetes Self-Care Activities (SDSCA) questionnaire will also be validated in this phase. The qualitative phase will use qualitative content analysis with in-depth and semi-structured individual interviews to explore pregnant women's understanding of the impact of the Centering Pregnancy group care model on their care process. The mixed phase will focus on the degree and extent of convergence between quantitative and qualitative data.

DISCUSSION

The implementation of the Centering Pregnancy group care approach is anticipated to empower women in effectively managing their diabetes during pregnancy, resulting in improved outcomes for both mothers and newborns. Furthermore, adopting this approach has the potential to alleviate the financial burden of diabetes on healthcare system.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT): (IRCT20120718010324N80/ Date of registration: 2024-01-03). URL: https://irct.behdasht.gov.ir/trial/74206 .

Concerns, Worries, and Fears During Pregnancy in Active-Duty United States Air Force Families

There are no published studies on pregnancy-related concerns, worries, and fears (CWFs) in primiparous and multiparous women and men in U.S. Air Force (USAF) families. Reflecting a biopsychosocial model of behavioral health, women's and men's pregnancy-related CWF Questionnaires were developed. Usable data were obtained from 260 women and 243 men in USAF families. Similarities and differences in pregnancy-related CWFs were found when USAF and general population data were compared. The present findings can inform not only the general provision of pregnancy health-related services but also USAF secondary prevention pregnancy-related programs (e.g., USAF nurse home visiting programs for first-time parents). If CWF Questionnaires are individually administered, the information can be used to tailor services to individual client needs.

Pregnancy stressors and postpartum symptoms of depression and anxiety: the moderating role of a cognitive-behavioural therapy (CBT) intervention

Background

Little is known about the association between stressors (especially positive stressors) during pregnancy and postpartum depression and anxiety.

Aims

We investigated the association between positive and negative stress events during different stages of pregnancy and postpartum mental health outcomes among low-income pregnant women with symptoms of anxiety in Pakistan and evaluated whether an intervention based on cognitive-behavioural therapy (CBT) had a regulatory effect.

Methods

Participants were 621 pregnant Pakistani women with mild anxiety. Using the Pregnancy Experience Scale-Brief Version, six scores were created to assess positive and negative stressors. We performed a multivariate linear regression to examine whether these six scores, measured both at baseline and in the third trimester, were associated with postpartum anxiety and depressive symptoms. The effect of the intervention on this relationship was examined by adding an interaction term to the regression model.

Results

Hassles frequency measured in the third trimester was positively associated with depression (B=0.22, 95% confidence interval (CI): 0.09 to 0.36) and anxiety (B=0.19, 95% CI: 0.08to 0.30). At the same timepoint, uplifts intensity was negatively associated with symptoms of depression (B=-0.82, 95% CI: -1.46 to -0.18) and anxiety (B=-0.70, 95% CI: -1.25 to -0.15), whereas hassles intensity was positively related to symptoms of depression (B=1.02, 95% CI: 0.36 to 1.67) and anxiety (B=0.90, 95% CI: 0.34 to 1.47). The intensity ratio of hassles to uplifts reported in the third trimester was positively related to both depression (B=1.40, 95% CI: 0.59 to 2.20) and anxiety (B=1.26, 95% CI: 0.57 to 1.96). The intervention strengthened the overall positive effects of uplifts and the negative effects of hassles. Pregnancy experiences at baseline during early pregnancy to mid-pregnancy were not associated with mental health outcomes.

Conclusions

Stressors in the third trimester but not earlier in pregnancy were associated with postpartum symptoms of anxiety and depression. The CBT intervention modified the association between pregnancy stressors and postpartum mental health outcomes. Programmes that promote positive experiences and reduce negative experiences, especially in late pregnancy, may mitigate postpartum mental health consequences.

Trial registration number

NCT03880032.

Prenatal anticipatory stress: Baby preparation and worry scale-revised in the Dutch context

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.

The relationship between pregnancy and birth experience with maternal-fetal attachment and mother-child bonding: a descriptive-analytical study

BACKGROUND

Pregnancy and childbirth experience can be important factors for a pleasant relationship between mother and baby. This study assessed the relationship between the pregnancy and birth experience with maternal-fetal attachment (MFA) and mother-child bonding.

METHODS

A descriptive-analytical study was conducted among 228 pregnant women in Tabriz, Iran February 2022 to March 2023. Using cluster random sampling method, we included 228 women with gestational age 28-36 weeks and followed them up until six weeks postpartum. Data were collected in two stages using the following questionnaires: Pregnancy Experience Scale (hassles and uplifts), Maternal-Fetal Attachment Questionnaire (during the third trimester of pregnancy), Postpartum Bonding Questionnaire, and Childbirth Experience Questionnaire (six weeks postpartum). Data were analyzed using Pearson's correlation test and general linear model.

RESULTS

The mean score of MFA was significantly higher among women with feelings of being uplifted during pregnancy [β (95% CI) = 1.14 (0.87 to 1.41); p < 0.001]. However, there was no statistically significant relationship between pregnancy hassles and MFA and mother-child bonding (p > 0.05). Also, there was no statistically significant relationship between childbirth experience and mother-child bonding (p > 0.05).

CONCLUSION

According to the results of this study, pregnancy uplifts have a positive role in improving MFA. Therefore, it is recommended to plan interventions to make pregnancy period a pleasant experience for mothers.

Traversing mental health disorders during pregnancy: Lebanese women's experiences of antepartum depression and anxiety

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.

Psychometric performance assessment of the Arabic version of the pregnancy experience scale-brief version (PES-brief) in an Arabic-speaking population

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.

Development and evaluation of the psychometric properties of a digital questionnaire for the evaluation of perinatal psychosocial needs

BACKGROUND

If the purpose of maternal education is for women to take control of their own health and that of their family in the process, it is essential to have a simple instrument that allows them to self-assess, globally, how prepared they are to face future childbirth and maternity. As there is nothing similar in our area, the objective of this study was to design a complete, specific measurement questionnaire, with good metric quality and in digital format, for the assessment of perinatal psychosocial needs.

METHODS

A cross-sectional study was carried out, to evaluate the psychometric properties of a digital measurement questionnaire. The questionnaire was developed in 4 steps following the recommendations of the International Test Commission. The participants were 263 pregnant women who were recruited in primary health care appointments in the Basque Healthcare Service (Osakidetza); they completed the newly created questionnaire and all the test selected as gold standard. Their mean age was 33.55 (SD = 4.73). The analysis of the psychometric characteristics was based on mixed expert judgment procedures (focus group of healthcare professionals, item assessment questionnaire and interviews with users) and quantitative procedures (EFA, CFA, association with the gold standard and classification agreement index, ordinal alpha and McDonald's omega).

RESULTS

The final version of the questionnaire was made up of 55 items that evaluate 8 aspects related to perinatal psychosocial well-being (anxious-depressive symptoms, pregnancy acceptance, partner support, coping, internal locus of control, childbirth self-efficacy, perception of childbirth as a medicalized event, and fear of childbirth). Various tests were made of the validity and reliability of the scores, providing metric guarantees for their use in our context.

CONCLUSIONS

The use of this complete, quick-to-use tool with good psychometric properties will allow pregnant women to take stock of their situation, assess whether they have the necessary resources in the psychological and social sphere, and work together with midwives and other health professionals in the areas that are lacking.

Pregnancy through the Looking-Glass: correlates of disordered eating attitudes among a sample of Lebanese pregnant women

INTRODUCTION

Despite the risks of gestational disordered eating for both the mother and fetus, research into this subject is scarce within developing countries, particularly in Lebanon. Our study's objective was to delve into the predictors of disordered eating attitudes during pregnancy among a sample of Lebanese pregnant women while assessing the potential mediating effect of body dissatisfaction between psychosocial factors and disordered eating attitudes in pregnancy.

METHODS

We framed a cross-sectional study, built on self-report measures. Pregnant women of 18 years old and above were recruited from all the Lebanese governorates through an online survey (N = 433).

RESULTS

The results showed that higher pregnancy-specific hassles (Beta = 0.19), media and pregnant celebrities' influence (Beta = 0.22), and body dissatisfaction (Beta = 0.17) were significantly associated with increased disordered eating attitudes in pregnancy; whereas higher perceived social support (Beta = -0.03), lower socio-economic status (Beta = -0.84), and multigravidity (Beta = -0.96) were significantly associated with less disordered eating attitudes during pregnancy. Body dissatisfaction mediated the association between pregnancy-specific hassles and disordered eating attitudes, and between social appearance concerns and disordered eating attitudes.

CONCLUSION

Our study highlighted that antenatal care, particularly in Lebanon, should no longer be limited to biological monitoring but rather seek to identify possible eating disorders and mental health threats. Further investigations following longitudinal designs should pursue identifying additional correlates of gestational disordered eating in the clinical context, in furtherance of consolidating screening programs and building targeted treatment strategies.

Perceived Social Support and Women's Empowerment and Their Associations with Pregnancy Experiences in Anxious Women: A Study from Urban Pakistan

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.

Factors Associated with Prenatal Health Behaviors among Low-Income, Ethnic Minority Women

Less than one-third of pregnant women in the U.S. meet prenatal nutrition, exercise, and stress management health behavior guidelines. Low rates of these prenatal health behaviors have been especially observed among low-income, ethnic minority women, placing them and their infants at a disproportionally higher risk for health complications. Yet, few studies have identified factors associated with these prenatal health behaviors in this population. This study examined whether certain demographic (e.g., ethnicity) and psychosocial characteristics (i.e., coping, stress, pregnancy-specific stress, and depression) were associated with prenatal nutrition (i.e., high-fat food and fruit and vegetable intake), exercise, and stress management health behaviors in 100 low-income, pregnant women (39% African American, 30% foreign-born Latinas, 15% U.S.-born Latinas, 10% non-Hispanic white, and 6% Asian American/Pacific Islander) in southern California using an embedded, mixed-methods, cross-sectional design. Results demonstrated that ethnic minority women who experienced more stress and used more maladaptive coping strategies (e.g., avoidance) were particularly at risk of consuming more high-fat foods and engaging in less exercise and stress management during pregnancy. Qualitative responses revealed women's experiences with these prenatal health behaviors. These findings highlight the need for interventions and collaborative care models that target psychosocial factors in order to optimize prenatal health behaviors and health outcomes among ethnic minority women.

Comparison of pregnancy stress, impact and fear of COVID-19 between working and non-working pregnant women in Korea

The purpose of the study was to investigate and compare the pregnancy stress, impact and fear of COVID-19 between working and non-working pregnant women in Korea. The influencing factors of pregnancy stress considering the pandemic situation were explored in each group. A descriptive cross-sectional study design was used in the study. A total of 150 participants were recruited from Korean online communities where only women can register and exchange information about pregnancy and childbirth. The survey questionnaires included the Prenatal Distress Questionnaire, Pregnancy Experience Scale - brief, COVID-19 Experiences, and Fear of COVID-19. The survey data of 140 participants (74 working pregnant women and 66 non-working pregnant women) were analyzed. Working pregnant women appeared to have more pregnancy stress than non-pregnant women (p < 0.05). They described more concerns about labor and delivery, and caring for infant. Non-working pregnant women were having more negative impact of COVID-19 on pregnancy experience (p < 0.05). They had more concerns related to prenatal care, obtaining living supplies, and giving birth during the pandemic situation. There were no significant differences in fear of COVID-19 between groups. In both groups, negative pregnancy experience and pregnancy types were significantly related with higher pregnancy stress (p < 0.05). While pregnancy stress was significantly higher in the working pregnant women, the negative impact of COVID-19 on pregnancy experience was greater in the non-working pregnant women group. We suggest tailored prenatal management, education, and social supports considering the differences in psychological distress between the groups.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-04105-8.

Mindfulness-based childbirth and parenting for pregnant women with high fear of childbirth and their partners: outcomes of a randomized controlled trial assessing short- and longer-term effects on psychological well-being, birth and pregnancy experience

OBJECTIVES

Mindfulness-Based Childbirth and Parenting (MBCP) reduces mothers' anticipated fear of childbirth (FOC), nonurgent obstetric interventions during childbirth and may improve childbirth outcomes in women with high FOC (Veringa-Skiba et al, 2022). The aim of this study was to examine the short- and longer-term outcomes of MBCP on psychological well-being, pregnancy and birth experience, as compared to enhanced care-as-usual (ECAU), in pregnant women with high FOC and their partners.

DESIGN

Participants were randomly assigned to MBCP or ECAU and completed questionnaires preintervention (T1), immediately after intervention (T2), two to four weeks after childbirth (T3) and 16-20 weeks after childbirth (T4). Both intention-to-treat and per-protocol analyses were conducted.

SETTING

The courses were provided by trained midwives.

PARTICIPANTS

Participants included 141 pregnant women and 120 partners.

INTERVENTION

MBCP comprised a nine-weekly three-hour session mindfulness group course for pregnant couples; ECAU consisted of two 90-minute individual couple consultation sessions.

MEASUREMENTS

Measures of psychological well-being included measures like stress, depression, anxiety and fatigue. Measures of pregnancy and birth experience concerned experiencing uplifts during pregnancy, experienced fear of childbirth, labour pain and satisfaction with childbirth.

FINDINGS

No differences between MBCP and ECAU in the total group of birthing women were found. However, women with (at least an onset of) labour that participated in MBCP reported a better birth experience compared to ECAU at T3. Concerning the total partner group only one difference between MBCP and ECAU was found at T4; MBCP partners reported an increase in fatigue. However, in the partner risk group (i.e., partners with lower psychological well-being before intervention) partners experienced better psychological well-being at T2 and T3 after MBCP than ECAU.

KEY CONCLUSIONS

MBCP and ECAU demonstrate similar effects on psychological well-being, birth and pregnancy experience. However, MBCP appears superior to ECAU for labouring women in having a better childbirth experience and for partners at risk for psychological complaints in increasing their psychological well-being.

IMPLICATIONS FOR PRACTICE

MBCP only positively affects the childbirth experience of those who experience (onset of) natural birth. It might be advisable to include partners at risk for psychological complaints in the MBCP.

Effectiveness of mobile-based intervention Self-care for Pregnant Women at Work: A randomized controlled trial

OBJECTIVES

While the number of employed women has increased worldwide, they still have difficulties in practicing prenatal care at work. Previous studies have found that smartphone-based prenatal education has increased access to healthcare and contributed to improving pregnant women's health. The objective of this study was to evaluate the effectiveness of a mobile-based intervention-Self-care for Pregnant Women at Work (SPWW)-in enhancing the self-care practices of pregnant women who work.

METHODS

A randomized repeated measures design was used in the study. The 126 women were randomly assigned to either an intervention group that used the SPWW mobile application for 4 weeks or a control group that used an application that only had surveys. Both groups completed surveys at preintervention, week 2, and week 4 of their participation in the study. The primary study variables were work stress, pregnancy stress, fear of childbirth, pregnancy experience, and health practices in pregnancy.

RESULTS

A total of 116 participants' data (60 in the intervention group and 56 in the control group) were analyzed. Significant group-by-time interaction effects were noted for pregnancy stress, pregnancy hassles, and health practices in pregnancy. The effect size of the intervention was small to medium for pregnancy stress (d = -0.425), pregnancy uplifts (d = 0.333), pregnancy hassles (d = -0.599), and health practices in pregnancy (d = 0.490).

CONCLUSIONS

A mobile-based intervention using a comprehensive health application is effective in pregnant women at work. Developing educational content and methods targeted at this population would be helpful.

Cultural adaptation and psychometric validation of the Pregnancy Experience Scale–Brief version (PES-Brief) in Pakistani women with antenatal anxiety symptoms

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.

Associations Between Eating Attitudes, Mental Health, and Sexual Dysfunction during Pregnancy

This cross-sectional study looked into sexual dysfunctions in a sample of Lebanese pregnant women (N = 433) while assessing their psychopathological correlates. It was a first attempt in research to examine the role of disordered eating attitudes in pregnancy, using the Arabic version of the Disordered Eating Attitudes in Pregnancy Scale. The pre/post comparison in terms of sexual functioning was based on the women's recall, using the Pregnancy Sexual Response Inventory. According to the pregnant persons perceptions of their sexual functioning before and during pregnancy, 66.1% of the participants reported a lower frequency of sexual activity during pregnancy, 52.7% lower sexual desire, and 47.3% dyspareunia; 33% were sexually satisfied contrasted to 70% before pregnancy. Pregnancy was significantly associated with lower sexual outcomes compared to before. Higher anxiety and more disordered eating attitudes during pregnancy were significantly associated with lower sexuality composite scores. Our study accentuates the need for rigorous medical guidance on sexual activity during pregnancy and highlights dysfunctional eating behaviors and anxiety disorders as pejorative predictors of the sexual response among pregnant women. It thus sustains the hypothesis that mental health disorders pertain to the pathogenesis of sexual problems and should therefore be targeted in sexual health promotion during prenatal care.

Factors associated with duration of breastfeeding in women giving birth for the first time

Objective

To examine maternal, psychosocial, and pregnancy factors associated with breastfeeding for at least 6 months in those giving birth for the first time.

Methods

We performed a planned secondary analysis of an observational cohort study of 5249 women giving birth for the first time. Women were contacted at least 6 months after delivery and provided information regarding breastfeeding initiation, duration, and exclusivity. Maternal demographics, psychosocial measures, and delivery methods were compared by breastfeeding groups.

Results

4712 (89.8%) of the women breastfed at some point, with 2739 (58.2%) breastfeeding for at least 6 months. Of those who breastfed, 1161 (24.7% of the entire cohort), breastfed exclusively for at least 6 months. In the multivariable model among those who ever breastfed, not smoking in the month prior to delivery (adjusted odds ratio [aOR] 2.04, 95%CI 1.19–3.45), having a Master’s degree of higher (aOR 1.89, 95%CI 1.51–2.36), having a planned pregnancy (aOR 1.48, 95%CI 1.27–1.73), older age (aOR 1.02, 95% CI, 1.01–1.04), lower BMI (aOR 0.96 95% CI 0.95–0.97), and having less anxiety measured during pregnancy (aOR 0.990, 95%CI 0.983–0.998) were associated with breastfeeding for at least 6 months. Compared to non-Hispanic White women, Hispanic women, while being more likely to breastfeed initially (aOR 1.40, 95%CI 1.02–1.92), were less likely to breastfeed for 6 months (aOR 0.72, 95%CI 0.59–0.88). While non-Hispanic Black women were less likely than non-Hispanic White women to initiate breastfeeding (aOR 0.68, 95%CI 0.51–0.90), the odds of non-Hispanic Black women of continuing to breastfeed for at least 6 months was similar to non-Hispanic White women (aOR 0.92, 95%CI 0.71–1.19).

Conclusions

In this cohort of women giving birth for the first time, duration of breastfeeding was associated with several characteristics which highlight groups at greater risk of not breastfeeding as long as currently recommended.

Trial registration

NCT01322529 (nuMoM2b) and NCT02231398 (nuMoM2b-Heart Health)

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-05038-7.

Pregnant in a Pandemic: Connecting Perceptions of Uplifts and Hassles to Mental Health

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.

Comparing the effect of childbirth preparation courses delivered both in-person and via social media on pregnancy experience, fear of childbirth, birth preference and mode of birth in pregnant Iranian women: A quasi-experimental study

Background and aim

Rates of cesarean section in Iran are unnecessarily high largely due to fear of childbirth (FOC), yet this may be reduced through education. Iranian women are keen to obtain information about pregnancy and birth online though sources may not be reliable. Consequently, the present study aimed to compare the effect of childbirth preparation courses delivered both online via the social media platform ‘Telegram’ and in-person on pregnancy experience, FOC, birth preference, and mode of birth.

Methods

This quasi-experimental study included 165 primiparous pregnant women referred to the prenatal clinic in Tehran, Iran. Convenience sampling was used to recruit participants, who were subsequently divided into three groups; (A) social media-based educational intervention (n = 53); (B) in-person educational intervention (n = 52), and (C) a control group who received no prenatal education (n = 50). During the 18th and 20th weeks of pregnancy, demographic questions along with the pregnancy experience scale (PES), and version A of the Wijma delivery expectancy/experience questionnaire (WDEQ‑A) were completed. In the 36th and 38th weeks of pregnancy, the PES and WDEQ‑A questionnaires, as well as birth preference form were further completed. Mode of birth was recorded in the first few days of postpartum. The Fisher’s exact test, along with ANOVA and Chi-square tests were used to determine associations between variables. A paired t-test was used to examine within-group comparisons. The Kruskal–Wallis non-parametric test was used to investigate the intervening effect of economic status.

Results

Post intervention, the mean score of pregnancy experience and FOC did not differ significantly between the three groups. Also, 86.8% of participants in group A, 90.4% of participants in group B, and 62% of participants in the control group preferred to give birth vaginally, which was statistically significant (p = 0.001). Moreover, 66% of participants in group A, 61.5% of participants in group B, and 50% of participants in the control group ultimately gave birth vaginally. None of the participants in group A underwent an elective cesarean section, while this rate was 7.7% and 24% for groups B and control, respectively (p = 0.002).

Conclusion

Despite the non-significant differences identified between the three groups in terms of pregnancy experience and FOC, prenatal education delivered via social media may be usefully offered to Iranian women keen to receive education flexibly online.

Trial registration

Name of the Registry: Iranian Registry of Clinical Trials. Trial registration number: IRCT20180427039436N2. Date of registration: 15/06/2018. URL of trial registry record: https://www.irct.ir/trial/30890.

Associations Between Maternal Distress During Early Life Periods and Offspring Respiratory Infections and Allergic Outcomes

Background

Increasing evidence suggests that maternal distress is a risk factor for development of respiratory infections and allergic diseases in the offspring. We aim to evaluate the link between maternal distress during critical periods in early life, namely the preconception, pregnancy and postnatal periods, and development of respiratory infections and allergic diseases in the offspring from the Singapore PREconception Study of long Term maternal and child Outcomes (S-PRESTO) cohort.

Methods

Maternal perceived distress was evaluated using validated questionnaires including Beck Depression Inventory-II (BDI-II) administered during three time periods: preconception (three months apart at four timepoints), pregnancy (during each trimester) and postnatal (3 and 6 months post-delivery). Child eczema, rhinitis and wheeze outcomes were evaluated using a modified ISAAC questionnaire at ages 3, 6, 12, and 18 months. Child allergic sensitization was determined by skin prick testing at 18 months.

Results

Among 332 mother-child pairs studied, higher maternal distress during preconception and pregnancy increased the risks of wheeze development in the first 18 months; for example, preconception and pregnancy BDI-II scores ≥20 were associated with increased risks of wheeze by 18 months [adjusted risk ratios 3.2 (95%CI 1.1-9.4) and 2.5 (1.0-5.9), respectively]. Emotional and practical support from family during preconception decreased the risks of offspring wheeze. No associations were observed between maternal distress and offspring eczema, rhinitis and allergic sensitization.

Conclusion

Maternal distress during critical early life periods was associated with offspring wheeze in the first 18 months of life. Supporting maternal mental health even before pregnancy could reduce the risk of offspring wheeze.

Comparing the effect of in-person and virtual childbirth preparation trainings on the fear of childbirth (FOC) and pregnancy experience of pregnant women: protocol for a quasi-experimental feasibility study

Background

Childbirth preparation trainings are an important component of prenatal education, and pregnant women are increasingly interested in seeking information from online sources. The aim of this study is to compare the feasibility and the effects of in-person and virtual childbirth preparation training courses on the pregnancy experience, fear of childbirth (FOC), birth preference, and type of delivery among pregnant women.

Methods

In total, 165 primiparous women referring to a prenatal clinic at Milad Hospital in Tehran, will be included in this study. The subjects will be selected using the convenience sampling method and will be divided into three groups of study A, study B, and control. The study groups A and B will receive virtual and in-person childbirth training with similar content, respectively. The control group will receive only routine prenatal care. In the 18th and 20th weeks of pregnancy, the demographic information, pregnancy experience scale (PES), and version A of the Wijma delivery expectancy/experience questionnaire (WDEQ-A) will be completed, and in the 36th and 38th weeks of pregnancy, the PES and WDEQ-A questionnaires, as well as birth preference form will be completed. The type of delivery will be recorded in the first few days of postpartum.

Conclusion

This quasi-experimental clinical trial will investigate the effect of virtual childbirth preparation training on primiparous women. The expected outcomes will include the difference in pregnancy experience measured by the brief version of PES, the difference in FOC measured by WDEQ-A, the birth preference, and the type of delivery.

Trial registration

IRCT.ir: IRCT20180427039436N2;

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-021-00933-w.

Pregnancy and Infant Development (PRIDE)-a preliminary observational study of maternal adversity and infant development

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.

Massage During Pregnancy and Postpartum

Massage is systematic touch and manipulation of the soft tissues of the body that is increasingly being used as an adjunctive therapy for stress relief and to promote relaxation and wellbeing during pregnancy and as an alternative to pharmacologic or invasive forms of analgesia during labor. Literature to support the use of massage in pregnancy and labor is limited; however, evidence to support its use has been increasing over the past 30 years. Massage has been shown to be valuable to pregnant women with anxiety, depression, leg, and back pain, and has shown significant benefit in perception of pain during labor.

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

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.

Prenatal exposure to maternal depression is related to the functional connectivity organization underlying emotion perception in 8-10-month-old infants - Preliminary findings

Emotion perception is critical for infant's social development. Mother's mood during pregnancy has been associated with infants' emotional developmental risks. Graphtheory analysis was applied on EEG data recorded from 35, 8-to-10-month-old-infants prenatally exposed to high or low depressed symptoms, while viewing happy and sad faces. We found an interaction between group and emotion such that infants exposed to high-depressed-symptoms showed higher modularity - reflecting reduced perceptual-dynamics - for viewing happy emotions compared to sad. The opposite was observed for infants exposed to low-depressive-symptoms. These preliminary findings suggest that prenatal depressive mood may shape early functional organization for viewing emotional faces.

Development and validation of the prenatal activity restriction stress questionnaire: a Rasch rating scale analysis

Background

Antepartum activity restriction (AAR) is a common recommendation given to women at risk for preterm delivery. However, such treatment has been shown to cause heavy emotional burdens on the women receiving it since it requires them to face many challenges derived from the intervention. Nevertheless, current existing scales lack effective items that can reflect the distress of these women. The aim of this study was to develop a reliable instrument to assess the distress of women experiencing AAR.

Method

The Prenatal Activity Restriction Stress Questionnaire (PARSQ) was developed according to comprehensive literature review, women’s interviews, and existing pregnancy-special stress scales from August 2016 to July 2017 in southern Taiwan. Six experts evaluated its content validity; the Rasch rating scale model (RSM) was used to examine its item-fit, dimensionality, and reliability with 200 women with AAR experience. Furthermore, the concurrent validity was assessed through computing the correlation of AAR women’s scores on the PARSQ and Perceived Stress Scale (PSS), and discriminant validity of the PARSQ was assessed to compare the scores’ differences between the AAR women and the healthy pregnant women.

Results

The PARSQ was constructed with 23 items in the 4-dimensional scale: Role function changes (8 items), Fetal safety and health (5 items), Physical and psychological care issues (5 items), and Socioeconomic and medical issues (5 items). It was confirmed to have satisfactory content vitality (CVI = 0.78 to 1.0), reasonable item-fit (0.77 to 1.51), and good reliability in RSM model, as well as adequate concurrent validity (p = 0.005) and discriminant validity (p < 0.001).

Conclusions

Understanding the distress of women undergoing AAR is necessary for developing appropriate prenatal care to assist women in coping with their situation to alleviate their emotional burdens. The developed PARSQ with satisfied psychometric properties can be an informative instrument for clinicians/researchers to assess the specific stress of pregnant women with AAR.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-020-03347-3.

The bloom is (slightly) off the rose: the motherhood effect on psychological functioning in successive pregnancies

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.

Design and Psychometric Analysis of the Stressors and Modulators of Gestational Stress Inventory (SMGSI)

Gestational stress is associated with many maternal and child complications, however, this association must be taken with care, since there are studies that find inconsistent results between stress measures and maternal complications. It is believed that the lack of convergence is due to the way in which gestational stress is evaluated.The aim of the present study was to design and validate an instrument based on a bio-psycho-social model of gestational stress. The design and validation process of the inventory was divided into four phases: (a) Construction of the items bank and content validity, (b) construct validity, (c) inventory reliability and (d) convergent and discriminant validity with psychometric instruments that have been used in other investigations to evaluate gestational stress.A valid and reliable Stressors and Modulators of Gestational Stress Inventory (SMGSI) conformed by two scales was developed: (a) Gestational stressors, which is formed by two factors, the psychological stressors and social stressors with a variance of 48.5% and 51.8% and a reliability of .79 and .67, respectively; and (b) gestational stress modulators integrated by 8 items that explain 55.2% of the variance and with a reliability of .92. In conclusion, a valid and reliable tool was obtained that measures gestational stress from a bio-psycho-social perspective. This inventory allows for the identification of allostatic and pantostatic stress, making it useful as a diagnostic tool to prevent maternal and childhood complications that are associated with chronic gestational stress.

Psychosocial and Sociodemographic Contributors to Breastfeeding Intention in First-Time Mothers

OBJECTIVE

Breastfeeding has multiple benefits for women and babies. Understanding factors contributing to intention to exclusively breastfeed may allow for improving the rates in first-time mothers. The study objective was to examine factors associated with a woman's intention to breastfeed her first child.

METHODS

A secondary analysis of the prospective "Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be" (nuMoM2b) study of nulliparous women in the U.S. with singleton pregnancies was performed. Sociodemographic and psychosocial factors were analyzed for associations with breastfeeding intention.

RESULTS

For the 6443 women with complete information about breastfeeding intention and all factors under consideration, women who intended to breastfeed (either exclusively or any breastfeeding) were more likely to be older, not black, have reached a higher level of education, have higher incomes, have a lower body mass index (BMI), and be nonsmokers. Reporting a planned pregnancy and several psychosocial measures were also associated with intention to breastfeed. In the multivariable analysis for exclusive breastfeeding, in addition to age, BMI, race, income, education, and smoking, of the psychosocial measures assessed, only women with higher hassle intensity ratios on the Pregnancy Experience Scale had lower odds of exclusive breastfeeding intention (OR 0.71, 95% CI 0.55-0.92). Other psychosocial measures were not associated with either exclusive breastfeeding or any breastfeeding after controlling for demographic characteristics.

CONCLUSIONS FOR PRACTICE

Several sociodemographic factors, having a planned pregnancy, and fewer intense pregnancy hassles compared to uplifts are associated with intention to exclusively breastfeed. Identifying these factors may allow providers to identify women for focused, multilevel efforts to enhance breastfeeding rates.

Translation, cultural adaptation and validation of "Pregnancy Experience Scale" for Brazilian pregnant

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.

An investigation of dispositional mindfulness and mood during pregnancy

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.

Antenatal preparedness for motherhood and its association with antenatal anxiety and depression in first time pregnant women from India

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.

Correlates of the Pregnancy Experience and Attitude regarding Weight Change during Pregnancy in Primigravida Women

PURPOSE

We aimed to examine the correlations between pregnancy experience and attitude regarding weight change during pregnancy.

METHODS

This correlative study was conducted from July 2017 to October 2017 by involving 156 primigravida women who were over pregnancy 20 weeks in Seoul and Gyeonggi-do province. Data were collected using a questionnaire, which included questions on demographic data, experience during pregnancy, and attitude regarding weight change during pregnancy. Descriptive statistics were calculated. Also, independent t-test, ANOVA, and Pearson's correlation coefficients were used for data analysis.

RESULTS

The mean age of the participants was 30.62 years and their score of attitude regarding weight gain during pregnancy was low. Moreover, a significant correlation was found between the pregnancy experience and attitude regarding weight gain during pregnancy in primigravida women.

CONCLUSION

As a result of analyzing the correlation between pregnancy experience and attitude towards weight gain during pregnancy, it is apparent that attitudes toward weight change are different according to experience during pregnancy in women. Based on these results, it can be concluded that nursing intervention programs are necessitated to enhance the attitude of pregnant primigravida women towards pregnancy and weight gain.

Anxiety During Pregnancy and Postpartum: Course, Predictors and Comorbidity with Postpartum Depression

Previous findings on peripartum anxiety are inconsistent in respect to the prevalence and course of peripartum anxiety with comorbidity of depression. Our aim was threefold: (1) to examine the course of elevated anxiety during pregnancy, immediately after childbirth, and six weeks postpartum; (2) to establish comorbidity of postpartum anxiety and postpartum depression (PPD); and (3) to examine predictors of anxiety 6 weeks postpartum. A sample of women (N=272) who were below the cut-off score for clinical depression during pregnancy were assessed in the third trimester of pregnancy, then 2 days and 6 weeks postpartum. Questionnaires on anxiety, pregnancy specific distress, stress, coping styles, social support, and depression were administered at each assessment. Obstetric data were collected from the participants' medical records. The estimated rate of high anxiety was 35% during pregnancy, 17% immediately after childbirth, and 20% six weeks postpartum, showing a decrease in anxiety levels after childbirth. Comorbidity of anxiety and PPD was 75%. Trait anxiety and early postpartum state anxiety are significant predictors of postpartum anxiety. Anxiety is a common peripartum psychological disturbance. Anxiety symptoms overlap with PPD, but not com-pletely, indicating that screening for postpartum mental difficulties should include both depression and anxiety.

Anxiety During Pregnancy and Postpartum: Course, Predictors and Comorbidity with Postpartum Depression

Previous findings on peripartum anxiety are inconsistent in respect to the prevalence and course of peripartum anxiety with comorbidity of depression. Our aim was threefold: (1) to examine the course of elevated anxiety during pregnancy, immediately after childbirth, and six weeks postpartum; (2) to establish comorbidity of postpartum anxiety and postpartum depression (PPD); and (3) to examine predictors of anxiety 6 weeks postpartum. A sample of women (N=272) who were below the cut-off score for clinical depression during pregnancy were assessed in the third trimester of pregnancy, then 2 days and 6 weeks postpartum. Questionnaires on anxiety, pregnancy specific distress, stress, coping styles, social support, and depression were administered at each assessment. Obstetric data were collected from the participants' medical records. The estimated rate of high anxiety was 35% during pregnancy, 17% immediately after childbirth, and 20% six weeks postpartum, showing a decrease in anxiety levels after childbirth. Comorbidity of anxiety and PPD was 75%. Trait anxiety and early postpartum state anxiety are significant predictors of postpartum anxiety. Anxiety is a common peripartum psychological disturbance. Anxiety symptoms overlap with PPD, but not com-pletely, indicating that screening for postpartum mental difficulties should include both depression and anxiety.

The Relationship Between the Sexual Self and the Experience of Pregnancy

Studies reveal that prenatal health-care providers and educators often refrain from discussing sexuality with their patients. The present study explored the relationship between sexuality and pregnancy by considering whether the way in which women view themselves sexually is associated with their experience of pregnancy. Findings revealed that a positive sexual self was significantly related to a positive experience of pregnancy and that particular experiences of pregnancy were more significantly related to how women viewed themselves sexually than others. The findings encourage further discussion regarding the role that comprehensive sex education and training of prenatal health-care providers might play in ultimately establishing open, honest, and nonjudgmental discussions about sexuality between providers and their pregnant patients and partners.

Maternal distress and hair cortisol in pregnancy among women with elevated adverse childhood experiences

Life-course exposure to stress is associated with a wide-range of health outcomes. Early childhood adversity may affect an individual's future response to stress. This is of particular concern during pregnancy as early maternal stress may impact the stress response in pregnancy, altering fetal exposure. We therefore hypothesized maternal childhood adversity may interact with distress experienced in pregnancy affecting maternal cortisol accumulation in pregnancy. Analyses were conducted within the PRegnancy and Infant Development (PRIDE) Study, a cohort of mother-infant pairs participating in Every Child Succeeds, a home visiting program in Cincinnati, Ohio. Thirty (of 53) healthy pregnant mothers contributed a hair sample and completed a battery of psychologic and stress measures including the Adverse Childhood Experiences (ACE) Scale. We used linear models to estimate the association between symptoms of depression, anxiety, somatization, both pregnancy and perceived stress and cortisol deposition; we generated multiplicative interaction terms generated and models stratified by the dose of ACEs (≥2/<2). Although overall the associations between maternal psychological distress were not associated with hair cortisol, among women who experienced ≥2 ACEs, depressive, somatic, and anxiety symptoms and perceived stress during pregnancy were positively (and significantly for depressive and somatic) correlated with cortisol accumulation. Pregnancy-specific stress was inversely associated with cortisol and also varied by ACEs. Interactions were non-significant (p values 0.11-0.51). We identified an association between measures of distress in pregnancy and hair cortisol only among mothers who experienced high levels of childhood adversity demonstrating importance of recognizing life-course stress.

Reducing Psychological Stress in Peripartum Women With Heart Rate Variability Biofeedback: A Systematic Review

Peripartum women are exposed to a variety of stressors that have adverse health consequences for the maternal-child dyad (e.g., impaired bonding). To combat these adverse health consequences, heart rate variability biofeedback (HRVBF) may be implemented by holistic nurses to aid peripartum women experiencing a high level of stress. A systematic review was completed using the guidelines established in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. To be included in the review, studies had to meet the following criteria: (a) published scientific articles, (b) studies published in English, (c) experimental, quasi-experimental, or case reports, (d) use of HRVBF as the main treatment, (e) use of psychological stress as a dependent variable, and (f) studies published until December 2017. The major findings of this review can be described as follows: (a) HRVBF and psychological stress in peripartum women are related concepts, (b) peripartum women who completed HRVBF report a reduction in stress compared with participants who did not receive HRVBF, and (c) there is currently no information on the effectiveness of HRVBF on psychological stress in the first and early second trimester of pregnancy. Overall, this systematic review of the literature provides objective evidence that HRVBF may be a potential beneficial adjuvant treatment for stress management in peripartum women.

The Ontario Birth Study: A prospective pregnancy cohort study integrating perinatal research into clinical care

BACKGROUND

Pregnancy and early childhood represent critical periods that impact health throughout the life-course. The Ontario Birth Study (OBS) is a pregnancy cohort study designed as a platform for research on pregnancy complications, maternal and infant health, and the developmental origins of health and disease.

METHODS

Pregnant women <17 weeks gestational age were recruited between 2013 and 2015 from antenatal clinics at Mount Sinai Hospital, Toronto, Canada. Life style and diet questionnaires, biospecimens, and clinical data were collected throughout the pregnancy and postpartum period at the time of clinical care. The OBS was integrated into clinical care to reduce participant burden, improve efficiency, and increase research potential.

RESULTS

There were 3181 eligible women approached for recruitment and 1374 (43%) participated in the study. Among the 1374 participants, 1272 (93%) delivered a liveborn infant and were followed to 6-10 weeks postpartum. Of the 1272 women who completed the study, 98% had at least one pregnancy blood sample collected, 97% had vaginal swabs collected, 90% completed the prenatal life style questionnaires, and 78% completed the Diet History Questionnaire. Most women (88%) were ≥30 years of age, 55% had no previous children, 24% were overweight or obese pre-pregnancy and 78% of parents had postsecondary education. Most pregnancies were singleton (3% twins), 34% delivered by caesarean section, and 6% preterm (<37 weeks gestation).

CONCLUSIONS

The OBS is a contemporary cohort with detailed data including banked biospecimens for studies of pregnancy health and the gene-environment interactions that establish developmental trajectories to health, learning, and social functioning.

The impact of psychological distress during pregnancy on the developing fetus: biological mechanisms and the potential benefits of mindfulness interventions

The in utero environment plays an essential role in shaping future growth and development. Psychological distress during pregnancy has been shown to perturb the delicate physiological milieu of pregnancy, and has been associated with negative repercussions in the offspring, including adverse birth outcomes, long-term defects in cognitive development, behavioral problems during childhood and high baseline levels of stress-related hormones. Fetal epigenetic programming, involving epigenetic processes, may help explain the link between maternal prenatal stress and its negative effects on the child. Given the potential long-term effects of early-life stress on a child's health, it is crucial to minimize maternal distress during pregnancy. A number of recent studies have examined the usefulness of mindfulness-based programs to reduce prenatal psychological stress and improve maternal psychological health, and these are reviewed here. Overall, the findings are promising, but more research is needed with large studies using randomized controlled study designs. It remains unclear whether or not such interventions could also improve child health outcomes, and whether these changes are modulated at the epigenetic level during fetal development. Further studies in this area are needed.

Positive feelings during pregnancy, early feeding practices, and infant health

BACKGROUND

Early parenting practices, such as infant feeding, can affect children's physical health. Additionally, negative prenatal maternal affect can influence feeding choices, such as breast-feeding, and can have a detrimental effect on children's health. Little is known, however, about the contribution of positive maternal affect during pregnancy on feeding practices and children's health.

METHODS

This study explored whether positive prenatal feelings influenced children's health during the first 18 months, and whether early feeding practices mediated the relationship between these two variables. Low-income, ethnically diverse, primiparous women (n = 114) reported their feelings of pregnancy uplifts and hassles during their third trimester. These women were interviewed again at 2, 4, 6, 9, 12, and 18 months post-partum about their feeding practices. A retrospective audit of their infants' medical charts was completed from birth to 18 months.

RESULTS

Using structural equation modeling, having more uplifts than hassles during pregnancy was associated with longer breast-feeding duration and greater adherence to recommended schedules for introducing fruits and vegetables, solids, and baby cereal. These feeding practices were linked to better child health outcomes, including reduced risk of upper respiratory tract infections, conjunctivitis, otitis media, and thrush.

CONCLUSIONS

Positive maternal feelings during pregnancy were associated with better feeding practices, and these better feeding practices were associated with fewer common childhood illnesses. Helping expectant women focus on the positive aspects of their pregnancy may lead to postnatal care methods that are fiscally advantageous, preventive of detrimental postnatal choices, and medically beneficial for children.

Validation of the Dutch version of the Pregnancy Experience Scale

The Pregnancy Experience Scale - Brief version (PES-Brief) assesses the frequency and intensity of the hassles and uplifts of pregnancy. This study aimed to assess the psychometric properties of the Dutch PES-Brief-Beleving van Zwangerschap Schaal - verkorte versie (BZS-K)-in a sample of healthy Dutch pregnant women. Participants (n=115) completed questionnaires twice during pregnancy, within a three-week interval. Factor analyses resulted in the expected two factors, one positive and one negative. The BZS-K showed sufficient internal consistency (α=.76 for Hassles, .83 for Uplifts) and reproducibility of subscales (Intraclass correlation coefficients (ICC)=.72-.84). Concurrent validity with measures of pregnancy anxiety, general depression, anxiety and stress, and emotional well-being was established. We conclude that the BZS-K is a reliable, valid measure for assessment of women's perceptions of hassles and uplifts of pregnancy.

Psychometric properties of stress and anxiety measures among nulliparous women

OBJECTIVE

To examine the psychometric properties of three measures, the perceived stress scale (PSS), pregnancy experience scale (PES), and state trait anxiety inventory (STAI), for assessing stress and anxiety during pregnancy among a large sample of nulliparous women.

METHODS

The sample included 10,002 pregnant women participating in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nMoM2b). Internal consistency reliability was assessed with Cronbach's alpha and factorial validity with confirmatory factor analyses. Intraclass correlations (ICCs) were calculated to determine stability of PSS scales over time. Psychometric properties were examined for the overall sample, as well as subgroups based on maternal age, race/ethnicity and language.

RESULTS

All three scales demonstrated good internal consistency reliability. Confirmatory factor analyses supported the factor structures of the PSS and the PES. However, a one-factor solution of the trait-anxiety subscale from the STAI did not fit well; a two-factor solution, splitting the items into factors based on direction of item wording (positive versus negative) provided a better fit. Scores on the PSS were generally stable over time (ICC = 0.60). Subgroup analyses revealed a few items that did not perform well on Spanish versions of the scales.

CONCLUSION

Overall, the scales performed well, suggesting they could be useful tools for identifying women experiencing high levels of stress and anxiety during pregnancy and allowing for the implementation of interventions to help reduce maternal stress and anxiety.