1
|
Hsu HW, Huang JP, Au HK, Lin CL, Chen YY, Chien LC, Chao HJ, Lo YC, Lin WY, Chen YH. Impact of miscarriage and termination of pregnancy on subsequent pregnancies: A longitudinal study of maternal and paternal depression, anxiety and eudaimonia. J Affect Disord 2024; 354:544-552. [PMID: 38479500 DOI: 10.1016/j.jad.2024.03.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/27/2024] [Accepted: 03/09/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Although miscarriage and termination of pregnancy affect maternal mental illnesses on subsequent pregnancies, their effects on the positive mental health (e.g., eudaimonia) of both first-time and multi-time parents have received minimal attention, especially for fathers. This longitudinal study examines the effects of experiences of miscarriage and termination on parental well-being in subsequent pregnancies from prenatal to postpartum years, while simultaneously considering parity. METHODS Pregnant women and their partners were recruited during early prenatal visits in Taiwan from 2011 to 2022 and were followed up from mid-pregnancy to 1 year postpartum. Six waves of self-reported assessments were employed. RESULTS Of 1813 women, 11.3 % and 14.7 % had experiences of miscarriage and termination, respectively. Compared with the group without experiences of miscarriage or termination, experiences of miscarriage were associated with increased risks of paternal depression (adjusted odds ratio = 1.6, 95 % confidence interval [CI] = 1.13-2.27), higher levels of anxiety (adjusted β = 1.83, 95 % CI = 0.21-3.46), and lower eudaimonia scores (adjusted β = -1.09, 95 % CI = -1.99 to -0.19) from the prenatal to postpartum years, particularly among multiparous individuals. Additionally, experiences of termination were associated with increased risks of depression in their partner. LIMITATIONS The experiences of miscarriage and TOP were self-reported and limited in acquiring more detailed information through questioning. CONCLUSIONS These findings highlight the decreased well-being of men whose partners have undergone termination of pregnancy or experienced miscarriage, and stress the importance of interventions aimed at preventing adverse consequences among these individuals.
Collapse
Affiliation(s)
- Hsueh-Wen Hsu
- Master Program in Applied Epidemiology, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Jian-Pei Huang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Heng-Kien Au
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chen-Li Lin
- Department of Obstetrics & Gynecology, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan
| | - Yi-Yung Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ling-Chu Chien
- School of Public Health, College of Public Health, Taipei Medical University, New Taipei City, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
| | - Hsing Jasmine Chao
- School of Public Health, College of Public Health, Taipei Medical University, New Taipei City, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chun Lo
- Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan; Ph.D Program in Medical Neuroscience, College of Medical Science and Techonology, Taipei Medical University, New Taipei City, Taiwan
| | - Wen-Yi Lin
- Ph.D. Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, New Taipei City, Taiwan
| | - Yi-Hua Chen
- School of Public Health, College of Public Health, Taipei Medical University, New Taipei City, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan; Research Center of Health Equity, College of Public Health, Taipei Medical University, New Taipei City, Taiwan.
| |
Collapse
|
2
|
Camacho EM, Gold KJ, Murphy M, Storey C, Heazell AEP. Measuring EQ-5D-5L utility values in parents who have experienced perinatal death. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-024-01677-z. [PMID: 38403720 DOI: 10.1007/s10198-024-01677-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/18/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Policymakers use clinical and cost-effectiveness evidence to support decisions about health service commissioning. In England, the National Institute for Health and Care Excellence (NICE) recommend that in cost-effectiveness analyses "effectiveness" is measured as quality-adjusted life years (QALYs), derived from health utility values. The impact of perinatal death (stillbirth/neonatal death) on parents' health utility is currently unknown. This knowledge would improve the robustness of cost-effectiveness evidence for policymakers. OBJECTIVE This study aimed to estimate the impact of perinatal death on parents' health utility. METHODS An online survey conducted with mothers and fathers in England who experienced a perinatal death. Participants reported how long ago their baby died and whether they/their partner subsequently became pregnant again. They were asked to rate their health on the EQ-5D-5L instrument (generic health measure). EQ-5D-5L responses were used to calculate health utility values. These were compared with age-matched values for the general population to estimate a utility shortfall (i.e. health loss) associated with perinatal death. RESULTS There were 256 survey respondents with a median age of 40 years (IQR 26-40). Median time since death was 27 months (IQR 8-71). The mean utility value of the sample was 0.774 (95% CI 0.752-0.796). Utility values in the sample were 13% lower than general population values (p < 0.05). Over 10 years, this equated to a loss of 1.1 QALYs. This reduction in health utility was driven by anxiety and depression. CONCLUSIONS Perinatal death has important and long-lasting health impacts on parents. Mental health support following perinatal bereavement is especially important.
Collapse
Affiliation(s)
- Elizabeth M Camacho
- Institute of Population Health, University of Liverpool, Liverpool, UK.
- School of Health Sciences, University of Manchester, Manchester, UK.
| | - Katherine J Gold
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Margaret Murphy
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Claire Storey
- Tommy's Stillbirth Research Centre, University of Manchester, Manchester, UK
| | - Alexander E P Heazell
- Maternal and Fetal Health Research Centre, School of Medical Sciences, University of Manchester, Manchester, UK
- Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
3
|
Jones SL, De Braga V, Caccese C, Lew J, Elgbeili G, Castellanos-Ryan N, Parent S, Muckle G, Herba CM, Fraser WD, Ducharme S, Barnwell J, Trasler J, Séguin JR, Nguyen TV, Montreuil TC. Prenatal paternal anxiety symptoms predict child DHEA levels and internalizing symptoms during adrenarche. Front Behav Neurosci 2024; 17:1217846. [PMID: 38239262 PMCID: PMC10794355 DOI: 10.3389/fnbeh.2023.1217846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/30/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction This study examined (1) whether measures of paternal anxious and depressive symptoms collected prenatally and during a follow-up assessment when the child was in middle childhood, predict child neuroendocrine outcomes, and (2) whether neuroendocrine outcomes are intermediate factors between paternal mental health and child cognitive/behavioral outcomes. Middle childhood coincides with increased autonomy as the child transitions into grade school, and with adrenarche, as the maturing adrenal gland increases secretion of dehydroepiandrosterone (DHEA) and its sulfated metabolite (DHEA-S), hormones that are implicated in corticolimbic development which regulate emotions and cognition. Methods Participants were recruited from a subsample of a large prospective birth cohort study (3D study). We conducted a follow-up study when children were 6-8 years old (N = 61 families, 36 boys, 25 girls). Parental symptoms of anxiety, stress and depression were assessed via validated self-report questionnaires: prenatally using an in-house anxiety questionnaire, the Perceived Stress Scale (PSS) and the Center for Epidemiologic Studies Depression (CES-D), and at the follow up, using the Beck Anxiety and Beck Depression Inventories. Children provided salivary hormone samples, and their pituitary gland volume was measured from structural Magnetic Resonance Imaging (MRI) scans. Child behaviors were measured using the Strengths and Difficulties Questionnaire and cognitive outcomes using the WISC-V. Multiple regression analyses were used to test whether paternal mental health symptoms assessed prenatally and during childhood are associated with child neuroendocrine outcomes, adjusting for maternal mental health and child sex. Indirect-effect models assessed whether neuroendocrine factors are important intermediates that link paternal mental health and cognitive/behavioral outcomes. Results (1) Fathers' prenatal anxiety symptoms predicted lower DHEA levels in the children, but not pituitary volume. (2) Higher prenatal paternal anxiety symptoms predicted higher child internalizing symptoms via an indirect pathway of lower child DHEA. No associations were detected between paternal anxiety symptoms measured in childhood, and neuroendocrine outcomes. No child sex differences were detected on any measure. Conclusion These results highlight the often-overlooked role of paternal factors during pregnancy on child development, suggesting that paternal prenatal anxiety symptoms are associated with child neuroendocrine function and in turn internalizing symptoms that manifest at least up to middle childhood.
Collapse
Affiliation(s)
- Sherri Lee Jones
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Research Institute of the McGill University Health Center, Montreal, QC, Canada
- Department of Psychiatry, Douglas Research Center, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Victoria De Braga
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Research Institute of the McGill University Health Center, Montreal, QC, Canada
- School of Medicine, McGill University, Montreal, QC, Canada
| | - Christina Caccese
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | - Jimin Lew
- Department of Psychiatry, Research Institute of the McGill University Health Center, Montreal, QC, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | - Guillaume Elgbeili
- Department of Psychiatry, Research Institute of the McGill University Health Center, Montreal, QC, Canada
- Department of Psychiatry, Douglas Research Center, Douglas Mental Health University Institute, Montreal, QC, Canada
| | | | - Sophie Parent
- School of Psychoeducation, Université de Montréal, Montreal, QC, Canada
| | - Gina Muckle
- Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec, School of Psychology, Laval University, Québec, QC, Canada
| | - Catherine M. Herba
- Centre Hospitalier Universitaire (CHU) Ste-Justine Research Centre, Université de Montréal, Montreal, QC, Canada
- Department of Psychology, Université du Québec à Montréal (UQAM), Montreal, QC, Canada
| | - William D. Fraser
- Centre Hospitalier Universitaire (CHU) Ste-Justine Research Centre, Université de Montréal, Montreal, QC, Canada
- Department of Obstetrics and Gynecology, Centre de Recherche du CHU de Sherbrooke, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Simon Ducharme
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Douglas Research Center, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Julia Barnwell
- Department of Psychiatry, Research Institute of the McGill University Health Center, Montreal, QC, Canada
- Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Human Genetics and Pharmacology and Therapeutics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Jacquetta Trasler
- Department of Psychiatry, Research Institute of the McGill University Health Center, Montreal, QC, Canada
- Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Human Genetics and Pharmacology and Therapeutics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Jean R. Séguin
- Centre Hospitalier Universitaire (CHU) Ste-Justine Research Centre, Université de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
| | - Tuong-Vi Nguyen
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Research Institute of the McGill University Health Center, Montreal, QC, Canada
- Reproductive Psychiatry Program, McGill University Health Centre, Departments of Psychiatry and Obstetrics and Gynecology, Montreal, QC, Canada
| | - Tina C. Montreuil
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Research Institute of the McGill University Health Center, Montreal, QC, Canada
- Centre Hospitalier Universitaire (CHU) Ste-Justine Research Centre, Université de Montréal, Montreal, QC, Canada
- Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| |
Collapse
|
4
|
McKenna F, Gibbons M, Imcha M, Duffy RM, Mohamad MM. Anxiety in a Specialist Perinatal Mental Health Service: patient characteristics, management, and outcomes. Ir J Psychol Med 2023; 40:561-565. [PMID: 36789630 DOI: 10.1017/ipm.2023.4] [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] [Indexed: 02/16/2023]
Abstract
OBJECTIVES To outline characteristics of patients with anxiety diagnoses attending a Specialist Perinatal Mental Health Service (SPMHS) in Ireland, the mental health care received by those patients, mental health and obstetric outcomes for those patients, and immediate neonatal outcomes for their babies. METHODS A retrospective chart review was conducted of patients with antenatal anxiety diagnoses who attended the SPMHS in University Maternity Hospital Limerick, from initiation of the service to the end of its first year. RESULTS Data were collected on 100 patients, 81 with a mental health diagnosis prior to attending the SPMHS, 32 with prior engagement with psychiatry, and 23 with a previous perinatal diagnosis. The mean age of patients was 32.4 (19-47, std 6.158). Beyond initial assessment, the Mental Health Midwife was involved in the care of 61% of patients, more than any other specialty including psychiatry. Twenty-seven patients had psychiatric medication either started or altered by the SPMHS. The most common reason for eventual discharge was that patients were well. Two patients presented in mental-health-related crisis to emergency services and one patient was admitted to an acute psychiatric ward. CONCLUSIONS Patients attending the SPMHS for anxiety spanned a broad spectrum of demographics and diagnoses and received varied set of interventions. A significant proportion of patients had a primary diagnosis of Pregnancy-related anxiety. The Mental Health Midwife played a key role in management of these patients. Though rates of mental health crises and admissions were low, the absence of a Mother and Baby Unit in Ireland was highlighted.
Collapse
Affiliation(s)
- F McKenna
- Clare Psychiatry of Later Life, Ennis, Clare, Ireland
| | - M Gibbons
- Specialist Perinatal Mental Health Service, University Maternity Hospital Limerick, Limerick, Ireland
| | - M Imcha
- University Maternity Hospital Limerick, Limerick, Ireland
| | - R M Duffy
- Specialist Perinatal Mental Health Service, Rotunda Hospital, Dublin, Ireland
| | - M M Mohamad
- Specialist Perinatal Mental Health Service, University Maternity Hospital Limerick, Limerick, Ireland
| |
Collapse
|
5
|
Jones SL, Caccese C, Davis KP, Lew J, Elgbeili G, Herba CM, Barnwell J, Robert CH, Gavanski I, Horsley K, Fraser WD, Da Costa D, Séguin JR, Nguyen TV, Montreuil TC. Longitudinal associations between paternal mental health and child behavior and cognition in middle childhood. Front Psychol 2023; 14:1218384. [PMID: 38022974 PMCID: PMC10646505 DOI: 10.3389/fpsyg.2023.1218384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/13/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Paternal mental health has been associated with adverse consequences on offspring psychosocial development, and family environmental factors may partly explain those associations. To clarify this, we need comprehensive prospective studies, particularly in middle-childhood when the child enters school and is expected to make use of behavioral and cognitive skills as part of their interactions and learning. Method Using data from a sub-sample of the prospective 3D birth cohort study comprised of mother-father-child triads, and a follow-up of the parents and the children at 6-8 years of age (n = 61; 36 boys, 25 girls), we examined whether paternal anxious and depressive symptoms measured during the pregnancy period (i.e., prenatally) or concurrently when the child was assessed at 6-8 years old were associated with children's cognition/behavior. Results In contrast to our hypotheses, we found that greater prenatal paternal depressive symptoms predicted fewer child behavioral difficulties; and that greater concurrent childhood paternal depression or anxiety symptoms were associated with higher child full-scale IQ, controlling for the equivalent maternal mental health assessment and parental education. Father parenting perception did not mediate these associations, nor were they moderated by maternal mental health at the concurrent assessment, or paternal ratings of marital relationship quality. Discussion These findings suggest that higher symptoms of paternal mental health symptoms are associated with fewer child behavioral difficulties and higher cognitive performance in middle childhood. Potential clinical implications and future research directions are discussed.
Collapse
Affiliation(s)
- Sherri Lee Jones
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Douglas Research Center, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Christina Caccese
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Douglas Research Center, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Kelsey P. Davis
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Jimin Lew
- Department of Psychiatry, Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Douglas Research Center, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Integrated Program in Neuroscience, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Guillaume Elgbeili
- Department of Psychiatry, Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Catherine M. Herba
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
- Research Center, CHU Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
| | - Julia Barnwell
- Department of Psychiatry, Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
- Department of Pediatrics, Human Genetics and Pharmacology & Therapeutics, McGill University, Montreal, QC, Canada
| | - Cindy Hénault Robert
- Department of Psychiatry, Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Douglas Research Center, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | | | - Kristin Horsley
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - William D. Fraser
- Research Center, CHU Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
- Department of Obstetrics and Gynecology, Centre de Recherche du CHU de Sherbrooke, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Deborah Da Costa
- Department of Physical and Occupational Sciences, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Jean R. Séguin
- Research Center, CHU Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, QC, Canada
| | - Tuong-Vi Nguyen
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Reproductive Psychiatry Program, Department of Psychiatry and Obstetrics and Gynecology, McGill University Health Centre, Montreal, QC, Canada
| | - Tina C. Montreuil
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
- Research Center, CHU Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
- Department of Pediatrics, Human Genetics and Pharmacology & Therapeutics, McGill University, Montreal, QC, Canada
- Department of Educational and Counselling Psychology, Faculty of Education, McGill University, Montreal, QC, Canada
| |
Collapse
|
6
|
Psychogiou L, Ahun MN, Geoffroy MC, Brendgen M, Côté SM. Adolescents' internalizing symptoms predict dating violence victimization and perpetration 2 years later. Dev Psychopathol 2023; 35:1573-1583. [PMID: 35473624 DOI: 10.1017/s095457942200030x] [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] [Indexed: 11/06/2022]
Abstract
The aim of this longitudinal study was to examine bidirectional associations of adolescents' internalizing symptoms with dating violence victimization and perpetration. We conducted secondary analyses of the Québec Longitudinal Study of Child Development data (n = 974). Each adolescent completed items from the Conflict Tactics Scale (at ages 15 and 17 years) to assess psychological, physical, and sexual dating violence victimization and perpetration in the past 12 months. Adolescents' symptoms of depression and general anxiety in the past 12 months were self-reported (at ages 15 and 17 years) using The Mental Health and Social Inadaptation Assessment for Adolescents. There were concurrent associations of adolescents' internalizing symptoms with dating violence victimization and perpetration. Internalizing symptoms at age 15 years were positively associated with dating violence victimization and perpetration 2 years later in both males and females, even after adjusting for baseline characteristics. However, neither dating violence victimization nor perpetration at age 15 years was associated with internalizing symptoms 2 years later. For males and females, internalizing symptoms put adolescents at risk for future dating violence victimization and perpetration. Interventions that target internalizing symptoms may have the potential to decrease subsequent dating violence.
Collapse
Affiliation(s)
| | - Marilyn N Ahun
- Department of Social and Preventive Medicine, Université de Montréal School of Public Health, Montréal, QC, Canada
- Axe Cerveau et développement de l'enfant, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marie-Claude Geoffroy
- Department of Educational and Counselling Psychology, McGill University, Montréal, QC, Canada
| | - Mara Brendgen
- Axe Cerveau et développement de l'enfant, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada
- Department de psychologie, Université du Québec à Montréal, Montréal, QC, Canada
| | - Sylvana M Côté
- Department of Social and Preventive Medicine, Université de Montréal School of Public Health, Montréal, QC, Canada
- Axe Cerveau et développement de l'enfant, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada
| |
Collapse
|
7
|
Koert E, Hartwig TS, Hviid Malling GM, Schmidt L, Nielsen HS. 'You're never pregnant in the same way again': prior early pregnancy loss influences need for health care and support in subsequent pregnancy. Hum Reprod Open 2023; 2023:hoad032. [PMID: 37577178 PMCID: PMC10412407 DOI: 10.1093/hropen/hoad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/14/2023] [Indexed: 08/15/2023] Open
Abstract
STUDY QUESTION What are couples' needs for health care and support in a subsequent pregnancy after prior early pregnancy loss (PL) and how do needs change across the pregnancy? SUMMARY ANSWER Couples described unmet needs for pregnancy care in the first 20 weeks of pregnancy and were more satisfied with the care provided during the remainder of the pregnancy. WHAT IS KNOWN ALREADY Despite early PL being common (∼25% of pregnancies), there is a paucity of research to guide practice to optimize treatment and support future pregnancies. There has been low priority for the issue in research and a pervasive acceptance that couples should 'just try again' after experiencing PL. Women with prior PL report increased anxiety during the first trimester of pregnancy compared to those without previous PL. No longitudinal studies explore what couples' needs are throughout the pregnancy and how these needs shift across time. STUDY DESIGN SIZE DURATION This was a qualitative longitudinal dyadic (joint) interview study. In total, 15 couples who were pregnant after a prior PL were interviewed four times over their pregnancy. Couples were recruited from the Copenhagen Pregnancy Loss Cohort Research Programme. Interviews were held in person at the hospital or university, or online. Interviews ranged from 20 to 91 min (mean = 54 min). PARTICIPANTS/MATERIALS SETTING METHODS Inclusion criteria included couples with one to two prior early PL(s) who self-reported a new pregnancy and were willing to be interviewed together and in English. Couples were interviewed four times: after a positive pregnancy test and once in each trimester. Interviews were transcribed and data were analysed using thematic analysis to compare and contrast needs of the couples at each of the four time periods in the pregnancy and across the entire pregnancy. One same-sex couple and 14 heterosexual couples participated. MAIN RESULTS AND THE ROLE OF CHANCE Couples' needs were categorized into two main longitudinal themes across the pregnancy, divided by the 20-week scan. Within each longitudinal theme, there were two themes to represent each time period. In the longitudinal theme 'The first 20 weeks: a 'scary' gap in care' there were two themes: Positive pregnancy test: 'Tell them it's not the same pregnancy' and First trimester: 'We craved that someone was taking care of us'. The standard pregnancy care offered in the public healthcare system in Denmark includes a scan at 12 and 20 weeks. While all couples wished for additional access to scans and monitoring of the foetus in early pregnancy to provide reassurance and detect problems early, they described considerable variation in the referrals and care they were offered. Both partners expressed a high degree of worry and anxiety about the pregnancy, with pregnant women in particular describing 'surviv[ing] from scan to scan' in the early weeks. Couples took scans wherever offered or paid for comfort scans, but this resulted in fragmented care. Instead, they wished for continuity in care, and acknowledgement and sensitivity that a pregnancy after PL is not the same as a first pregnancy. In the longitudinal theme 'The second 20 weeks: Safety in the care system' there were two themes: Second trimester: 'I think we are in good hands' and Third trimester: 'It's more of a 'nice to know' everything is OK than a 'need to know'. Couples reported their distress was lower and overall needs for care were met during this time. They expressed general satisfaction with regular or extended antenatal support although, as in the first 20 weeks, additional acknowledgement and sensitivity regarding their history of PL was desired. Couples said they felt more secure given that they had access to a 24-hour telephone support by midwife/nurse if they had any concerns or questions. LIMITATIONS REASONS FOR CAUTION Participants were self-selected from an ongoing cohort study of patients presenting at hospital with PL. Single women were not included in the study. This study was limited to data collection in Denmark; however, other countries with public healthcare systems may have similar offerings with regard to their provision of antenatal care, care provided in recurrent pregnancy loss (RPL) clinics and the availability of private scans. WIDER IMPLICATIONS OF THE FINDINGS The findings underscore that an early PL creates an increased need for monitoring and care in a subsequent pregnancy. This study highlights a gap in pregnancy care for those with a history of PL given that their need for monitoring and support is high in the early weeks of a new pregnancy before they have access to antenatal care, and before they have had multiple PLs and can be referred to the RPL unit. STUDY FUNDING/COMPETING INTERESTS This project has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 101028172 for E.K. The Copenhagen Pregnancy Loss Cohort is funded by a grant from the BioInnovation Institute Foundation. H.S.N. has received scientific grants from Freya Biosciences, Ferring Pharmaceuticals, BioInnovation Institute, Ministry of Education, Novo Nordisk Foundation, Augustinus Fonden, Oda og Hans Svenningsens Fond, Demant Fonden, Ole Kirks Fond, and Independent Research Fund Denmark. H.S.N. received personal payment or honoraria for lectures and presentations from Ferring Pharmaceuticals, Merck, Astra Zeneca, Cook Medical, Gedeon Richter, and Ibsa Nordic. All other authors declare no competing interests.
Collapse
Affiliation(s)
- E Koert
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen K, Denmark
- Department of Obstetrics and Gynecology, Amager Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - T S Hartwig
- Department of Obstetrics and Gynecology, Amager Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - G M Hviid Malling
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen K, Denmark
| | - L Schmidt
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen K, Denmark
| | - H S Nielsen
- Department of Obstetrics and Gynecology, Amager Hvidovre Hospital, Copenhagen University Hospital, Recurrent Pregnancy Loss Unit, Hvidovre, Denmark
| |
Collapse
|
8
|
Comparing prenatal and postpartum stress among women with previous adverse pregnancy outcomes and normal obstetric histories: A longitudinal cohort study. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 35:100820. [PMID: 36774741 DOI: 10.1016/j.srhc.2023.100820] [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: 10/06/2022] [Revised: 01/24/2023] [Accepted: 02/05/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE The aim of this study was to compare subjectively and objectively measured stress during pregnancy and the three months postpartum in women with previous adverse pregnancy outcomes and women with normal obstetric histories. METHODS We recruited two cohorts in southwestern Finland for this longitudinal study: (1) pregnant women (n = 32) with histories of preterm births or late miscarriages January-December 2019 and (2) pregnant women (n = 30) with histories of full-term births October 2019-March 2020. We continuously measured heart rate variability (HRV) using a smartwatch from 12 to 15 weeks of pregnancy until three months postpartum, and subjective stress was assessed with a smartphone application. RESULTS We recruited the women in both cohorts at a median of 14.2 weeks of pregnancy. The women with previous adverse pregnancy outcomes delivered earlier and more often through Caesarean section compared with the women with normal obstetric histories. We found differences in subjective stress between the cohorts in pregnancy weeks 29 and 34. The cohort of women with previous adverse pregnancy outcomes had a higher root mean square of successive differences between normal heartbeats (RMSSD), a well-known HRV parameter, compared with the other cohort in pregnancy weeks 26 (64.9 vs 55.0, p = 0.04) and 32 (63.0 vs 52.3, p = 0.04). Subjective stress did not correlate with HRV parameters. CONCLUSIONS Women with previous adverse pregnancy outcomes do not suffer from stress in subsequent pregnancies more than women with normal obstetric histories. Healthcare professionals need to be aware that interindividual variation in stress during pregnancy is considerable.
Collapse
|
9
|
Feduniw S, Modzelewski J, Kajdy A, Sys D, Kwiatkowski S, Makomaska-Szaroszyk E, Rabijewski M. Anxiety of pregnant women in time of catastrophic events, including COVID-19 pandemic: a systematic review and meta-analysis. J Psychosom Obstet Gynaecol 2022; 43:400-410. [PMID: 34633913 DOI: 10.1080/0167482x.2021.1985453] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE In March 2020, daily life was disrupted by the new virus SARS-CoV-2, which causes COVID-19. Pandemic-related prenatal anxiety could lead to depression, a risk factor for adverse pregnancy outcomes and abnormal neonatal development. This study aimed to investigate the impact of anxiety on the mental health of pregnant women exposed to catastrophic events as compared to those without such exposure. MATERIALS AND METHODS PubMed/MEDLINE, Web of Science, Cochrane Library, Scopus, and EMBASE were searched for relevant studies. This study compared the prevalence of anxiety among pregnant women during a catastrophic event. RESULTS Fifteen full texts were assessed for inclusion, with 3 included, 10 excluded for not meeting criteria, and 2 excluded for other reasons. The included studies were published before the current COVID-19 pandemic but included the SARS 2003 outbreak. During the current COVID-19 pandemic, 10 further studies were conducted, but they failed to meet the inclusion criteria. A meta-analysis of two studies using STAI revealed that women exposed to a catastrophic event had a higher mean STAI score of 1.82 points (95% CI: 0.47-3.18 points). CONCLUSION Women with complications during pregnancy should be assessed for anxiety independently from catastrophic events. During financial crises, environmental or other disasters, special attention should be given to women with low risk, normal pregnancies.
Collapse
Affiliation(s)
- Stepan Feduniw
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Jan Modzelewski
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Anna Kajdy
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Dorota Sys
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Sebastian Kwiatkowski
- Department Obstetrics and Gynecology, Pomeranian Medical University, Szczecin, Poland
| | | | - Michał Rabijewski
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| |
Collapse
|
10
|
Ramos IF, Campos B, Schetter CD. Pregnancy Anxiety and Beliefs Surrounding Motherhood in Latinas: A Qualitative Study. JOURNAL OF LATINX PSYCHOLOGY 2022; 10:277-290. [PMID: 36875871 PMCID: PMC9983568 DOI: 10.1037/lat0000208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objectives Prior research indicates that Latinas are at risk for experiencing high levels of anxiety during pregnancy. Pregnancy anxiety is a specific affective experience involving fears and worries about one's current pregnancy and it has been linked to heightened risk for preterm birth and developmental effects. Despite this concerning pattern, research has rarely examined Latina beliefs about the transition to motherhood and little is known about specific sources of pregnancy anxiety in Latinas, including whether fears are rooted in cultural concerns. The present study investigates the experiences of pregnancy anxiety among Latinas and explores their broader cultural beliefs surrounding pregnancy. Methods Fourteen pregnant Latinas articulated their experience of pregnancy anxiety, how they coped with their anxiety, and the beliefs they held surrounding pregnancy in 11 individual interviews and one focus group of three participants, all conducted in Spanish. Results Thematic analysis revealed that overall, Latinas felt that anxiety during pregnancy was normal, and that they worried about labor and delivery, losing their baby, their baby being born with a birth defect, and felt affected by the broader sociopolitical climate. Latinas felt lucky to be pregnant, believed that pregnancy was a blessing from God, and stressed the importance of maintaining a healthy pregnancy. Themes about family involvement and culturally-driven privileged status also emerged. Conclusions The present study highlights specific themes that may be important to consider in the context of Latina perinatal health. Such findings set the stage for future investigations examining the experience of anxiety specific to pregnancy in Latinas.
Collapse
|
11
|
Ahun MN, Psychogiou L, Guay F, Boivin M, Tremblay RE, Côté SM. Maternal depressive symptoms and children's academic performance: sex differences in the mediating role of school experiences. Psychol Med 2022; 52:2450-2459. [PMID: 33272330 DOI: 10.1017/s0033291720004298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Maternal depressive symptoms (MDSs) are negatively associated with children's academic performance, with stronger effects sometimes reported in boys. However, few studies have tested the mechanisms of this association. We examined the mediating role of school engagement and peer victimization in this association and tested for sex differences. METHODS Participants were 1173 families from a population-based longitudinal Canadian study. MDSs were self-reported annually using the Centre for Epidemiologic Studies Depression Scale (child's age: 5 months to 5 years). Data on mediators (peer victimization, cognitive, behavioral, and emotional school engagement) were reported annually from ages 6-10 by multiple informants including children, parents, and teachers using items from validated scales. Mathematics, reading, and writing exam scores at age 12 were obtained from standardized exams administered by Québec's Ministry of Education and Teaching. Structural equation modeling was used to test mediation by school experiences in boys and girls. RESULTS Exposure to MDSs was negatively associated with mathematics, reading, and writing scores in girls and with mathematics only in boys. Cognitive and behavioral engagement significantly mediated the association between MDSs and mathematics, reading, and writing scores in girls. There were no significant mediators for boys. CONCLUSIONS Prevention and intervention strategies aiming to improve school engagement might be beneficial for daughters of mothers experiencing depressive symptoms. Further research is needed to replicate these findings and to identify the mechanisms explaining this association in boys.
Collapse
Affiliation(s)
- Marilyn N Ahun
- Department of Social and Preventive Medicine, Université de Montréal, 7101 Avenue Parc, Montréal, Canada
- Centre Hospitalier Universitaire Sainte-Justine, 3175 chemin de la Côte Sainte-Catherine, Montréal, Canada
| | | | - Frédéric Guay
- Faculty of Educational Sciences, Université Laval, 2320 rue des Bibliothèques, Québec, Canada
| | - Michel Boivin
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, Québec, Canada
- Tomsk State University, 36 Lenin Avenue, Tomsk, Russia
| | - Richard E Tremblay
- University College Dublin, Belfield, Dublin 4, Ireland
- Department of Pediatrics, School of Psychology, Université de Montréal, 3175 chemin de la Côte Sainte-Catherine, Montréal, Canada
| | - Sylvana M Côté
- Department of Social and Preventive Medicine, Université de Montréal, 7101 Avenue Parc, Montréal, Canada
- Centre Hospitalier Universitaire Sainte-Justine, 3175 chemin de la Côte Sainte-Catherine, Montréal, Canada
- INSERM U1219, Université de Bordeaux, 146 rue Léo Saignat, Bordeaux, France
| |
Collapse
|
12
|
Wang DN, Weng XL, Gao LL. Mindfulness-based intervention in Chinese pregnant women with recurrent miscarriage: A non-randomized controlled study. Midwifery 2021; 103:103152. [PMID: 34601233 DOI: 10.1016/j.midw.2021.103152] [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: 12/22/2020] [Revised: 05/23/2021] [Accepted: 09/16/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Pregnant women with recurrent miscarriage have high rates of anxiety and depression. Mindfulness-based interventions have shown benefits in improving mental health in diverse populations; however, few studies have explored their efficacy in pregnant women with recurrent miscarriage, which was investigated in the present study. DESIGN A nonrandomized controlled study was carried out from August 2019 to November 2020. SETTING The study was conducted at a regional teaching hospital in Guangzhou, China that provides leading care for recurrent miscarriage. PARTICIPANTS A total of 158 pregnant women with recurrent miscarriage were recruited and allocated to the intervention group (n = 79) or the control group (n = 79); 131 women completed the study. INTERVENTION The mindfulness-based intervention consisted of a 1-h education session and daily mindfulness exercises guided by audio recordings during hospitalization. MEASUREMENTS AND FINDINGS Study outcomes included perceived stress measured with the Perceived Stress Scale; symptoms of anxiety and depression measured with the Self-rating Anxiety Scale and Edinburgh Postnatal Depression Scale, respectively; and positive and negative affect measured with the Positive Affect and Negative Affect Scale - Revised, respectively. Compared to the control group, participants in the intervention group showed significant decreases in perceived stress, depression symptoms, and negative affect and an increase in positive affect after the intervention. Anxiety increased significantly in the control group during the study but remained unchanged in the intervention group. KEY CONCLUSIONS A mindfulness-based intervention can reduce psychological symptoms and improve mental health in pregnant women with recurrent miscarriage. IMPLICATIONS FOR PRACTICE A mindfulness-based intervention should be incorporated into routine care to help improve the mental health of pregnant women with recurrent miscarriage.
Collapse
Affiliation(s)
- Dan-Ni Wang
- School of Nursing, Sun Yat-sen University, #74, Zhongshan Road II, Guangzhou, China, 510089.
| | - Xue-Ling Weng
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, #107, Yanjiang West Road, Guangzhou, China, 510120
| | - Ling-Ling Gao
- School of Nursing, Sun Yat-sen University, #74, Zhongshan Road II, Guangzhou, China, 510089.
| |
Collapse
|
13
|
Thébault-Dagher F, Robles M, Herba CM, St-Pierre J, Brochen C, Muckle G, Lupien SJ, Séguin JR, Fraser WD, Vaillancourt C, Lippé S. Febrile seizure incidence and age at first occurrence are associated with changes in placental normalized gene expression: the '3D' pregnancy cohort study. J Neuroendocrinol 2021; 33:e13046. [PMID: 34648210 DOI: 10.1111/jne.13046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/30/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
Self-reported maternal prenatal stress (MPS) has been associated with earlier febrile seizure (FS) age of onset in offspring. Studies are needed to understand how the biological systems associated with exposure to psychological MPS are linked to seizure disorders in children. The present study aimed to investigate whether placental markers of MPS are linked to FS incidence and age at first occurrence. A subsample of children with FS (n = 28) and matched controls (n = 84), were drawn from the longitudinal 3D pregnancy cohort (N = 2366 mother-child dyads). Expression of placental genes associated with glucocorticoids, serotonin and fetal/placental growth were analysed from placental tissues, compared between groups and associated with age at first FS. Overall placental normalized gene expression was statistically different (p < .001). Children with FS showed overexpression of the serotonin transporter (mean difference = 0.61, 95% confidence interval [CI] = 0.9-1.13), connexin 43 (mean difference = 0.69, 95% CI = 0.30-1.09), zonula occludens-1 (mean difference = 0.84, 95% CI = 0.42-1.26) and underexpression of glucocorticoid receptor β (mean difference = 0.84, 95% CI = -1.49 to 0.19) and serotonin receptor 2B (mean difference = 1.57, 95% CI = -2.35 to 0.78) compared to controls. Increased expression of the serotonin transporter predicted 37.2% in variation of age at first FS. The correlation matrix showed pregnancy-specific anxiety during the second trimester was moderately associated with age at first FS (r = -0.38) but was not a significant predictor in the regression model. Although our current results do not display a significant effect of self-reported MPS on FS, the present study is the first to show that placental gene biomarkers usually known to be associated with MPS display different expressions in children with FS. Specifically, our results suggest that placental genes associated with the glucocorticoid, serotonergic and fetal/placental growth systems may be candidate mechanisms leading to increased vulnerability offspring in FS. Because self-reported MPS was not found as a significant predictor in our statistical models, future studies are needed to investigate the mechanisms causing the observed changes in placental genes and their association with seizure disorders.
Collapse
Affiliation(s)
- Fanny Thébault-Dagher
- Department of Psychology, University of Montreal, Montreal, QC, Canada
- CHU Sainte-Justine Research Center, University of Montreal, Montreal, QC, Canada
| | - Morgane Robles
- INRS Armand-Frappier Santé Biotechnologique Research Center, Laval, QC, Canada
- Réseau intersectoriel de recherche en santé de l'Université du Québec, Québec, QC, Canada
| | - Catherine M Herba
- INRS Armand-Frappier Santé Biotechnologique Research Center, Laval, QC, Canada
- Réseau intersectoriel de recherche en santé de l'Université du Québec, Québec, QC, Canada
- Psychiatry and Addictology Department, University of Montreal, Montreal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Joey St-Pierre
- INRS Armand-Frappier Santé Biotechnologique Research Center, Laval, QC, Canada
- Réseau intersectoriel de recherche en santé de l'Université du Québec, Québec, QC, Canada
| | - Celia Brochen
- INRS Armand-Frappier Santé Biotechnologique Research Center, Laval, QC, Canada
| | - Gina Muckle
- School of Psychology, Université Laval, Laval, QC, Canada
- CHU de Québec-Université Laval Research Center, Québec, QC, Canada
| | - Sonia J Lupien
- Department of Psychology, University of Montreal, Montreal, QC, Canada
- Psychiatry and Addictology Department, University of Montreal, Montreal, QC, Canada
- Center for Studies on Human Stress, Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada
| | - Jean R Séguin
- CHU Sainte-Justine Research Center, University of Montreal, Montreal, QC, Canada
- Psychiatry and Addictology Department, University of Montreal, Montreal, QC, Canada
| | - William D Fraser
- Centre de recherche du CHU de Sherbrooke, Sherbrooke, QC, Canada
| | - Cathy Vaillancourt
- INRS Armand-Frappier Santé Biotechnologique Research Center, Laval, QC, Canada
- Réseau intersectoriel de recherche en santé de l'Université du Québec, Québec, QC, Canada
| | - Sarah Lippé
- Department of Psychology, University of Montreal, Montreal, QC, Canada
- CHU Sainte-Justine Research Center, University of Montreal, Montreal, QC, Canada
| |
Collapse
|
14
|
Yılmaz M, Değirmenci F, Yılmaz DV. A psychosocial examination of feelings and thoughts about pregnancy: A qualitative study. Midwifery 2021; 103:103106. [PMID: 34352598 DOI: 10.1016/j.midw.2021.103106] [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: 04/11/2020] [Revised: 04/15/2021] [Accepted: 05/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND during pregnancy, which is a developmental period, there are risks that may cause pathological changes when physical, mental and social adaptation is not achieved. During antenatal appointments, it is possible to provide necessary care for pregnant women at the right time by screening for risks that threaten health. In addition to physical risk factors, psychosocial risk factors that can have significant effects on the health of pregnant women should also be included in antenatal appointments. A woman's inability to meet her needs or difficulties encountered in psychosocial areas, such as mental health, family relations, social life and job status during pregnancy, may result in mental and social problems as well as physical problems. Insufficient social support, job loss and family communication problems can leave pregnant women vulnerable to stress and cause many pregnancy complications, such as preterm labor. When problems in these areas cannot be detected at an early stage, they can threaten the life of the woman and the fetus. As such, knowledge of the specific feelings and thoughts of pregnant women from a psychosocial perspective will be useful in the evaluation of psychosocial risk factors. PURPOSE to determine the feelings and thoughts of pregnant women from a psychosocial perspective. METHOD this study used a qualitative descriptive approach to investigate pregnancy-related feelings and thoughts in a sample of 23 healthy pregnant women. Data were collected using a personal information form and a semi-structured interview form. The interviews, which were conducted using the semi-structured interview form and individual in-depth interviews, were recorded on a voice recorder. A thematic approach was used to analyze the data. RESULTS according to the results, the mean age of the pregnant women was 30.39 (standard deviation 4.03) years, 73.9% were university graduates and 78.3% were multiparous. Three main themes ('Pregnancy perception', 'Emotions in pregnancy' and 'Psychosocial dimension of pregnancy') and eight subthemes emerged from the data analysis. For 'Pregnancy perception', the subtheme was 'Meaning of pregnancy'. For 'Emotions in pregnancy', the subthemes were 'Emotional status (mood) in pregnancy' and 'Fear in pregnancy'. For 'Psychosocial dimension of pregnancy', the subthemes were 'Reflections of pregnancy on social life', 'Reflections of pregnancy on body image', 'Reflections of pregnancy on sexual life', 'Reflections of pregnancy on marital relationship' and 'Reflections of pregnancy on working life'. CONCLUSIONS in order to protect and maintain the health of the mother and fetus during pregnancy, it is recommended that women should be provided with the best physical and psychosocial care within the context of social and cultural structure, not only in this period but in every stage of their lives.
Collapse
Affiliation(s)
- Mualla Yılmaz
- Department of Mental Health Nursing, Mersin University Faculty of Nursing, Mersin, Turkey
| | - Filiz Değirmenci
- Department of Obstetrics and Gynaecology Nursing, Mersin University Faculty of Nursing, Mersin 33343, Turkey.
| | - Duygu Vefikuluçay Yılmaz
- Department of Obstetrics and Gynaecology Nursing, Mersin University Faculty of Nursing, Mersin 33343, Turkey
| |
Collapse
|
15
|
Gerson KD, Mccarthy C, Ravel J, Elovitz MA, Burris HH. Effect of a Nonoptimal Cervicovaginal Microbiota and Psychosocial Stress on Recurrent Spontaneous Preterm Birth. Am J Perinatol 2021; 38:407-413. [PMID: 33032329 PMCID: PMC8026761 DOI: 10.1055/s-0040-1717098] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE While select cervicovaginal microbiota and psychosocial factors have been associated with spontaneous preterm birth, their effect on the risk of recurrence remains unclear. It is also unknown whether psychosocial factors amplify underlying biologic risk. This study sought to determine the effect of nonoptimal cervicovaginal microbiota and perceived stress on the risk of recurrent spontaneous preterm birth. STUDY DESIGN This was a secondary analysis of a prospective pregnancy cohort, Motherhood and Microbiome. The Cohen's Perceived Stress Scale (PSS-14) was administered and cervical swabs were obtained between 16 and 20 weeks of gestation. PSS-14 scores ≥30 reflected high perceived stress. We analyzed cervicovaginal microbiota using 16S rRNA sequencing and classified microbial communities into community state types (CSTs). CST IV is a nonoptimal cervicovaginal microbial community characterized by anaerobes and a lack of Lactobacillus. The final cohort included a predominantly non-Hispanic Black population of women with prior spontaneous preterm birth who had recurrent spontaneous preterm birth or term birth and had stress measurements (n = 181). A subanalysis was performed in the subset of these women with cervicovaginal microbiota data (n = 74). Multivariable logistic regression modeled adjusted associations between CST IV and recurrent spontaneous preterm birth, high stress and recurrent spontaneous preterm birth, as well as high stress and CST IV. RESULTS Among the 181 women with prior spontaneous preterm birth, 45 (24.9%) had high perceived stress. We did not detect a significant association between high stress and recurrent spontaneous preterm birth (adjusted odds ratio [aOR] 1.67, 95% confidence interval [CI]: 0.73-3.85). Among the 74 women with prior spontaneous preterm birth and cervicovaginal microbiota analyzed, 29 (39.2%) had CST IV; this proportion differed significantly among women with recurrent spontaneous preterm birth (51.4%) compared with women with term birth (28.2%) (p = 0.04). In models adjusted for race and marital status, the association between CST IV and recurrent spontaneous preterm birth persisted (aOR 3.58, 95% CI: 1.25-10.24). There was no significant interaction between stress and CST IV on the odds of spontaneous preterm birth (p = 0.328). When both stress and CST IV were introduced into the model, their associations with recurrent spontaneous preterm birth were slightly stronger than when they were in the model alone. The aOR for stress with recurrent spontaneous preterm birth was 2.02 (95% CI: 0.61-6.71) and for CST IV the aOR was 3.83 (95% CI: 1.30-11.33). Compared to women with neither of the two exposures, women with both high stress and CST IV had the highest odds of recurrent spontaneous preterm birth (aOR = 6.01, 95% CI: 1.002-36.03). CONCLUSION Among a predominantly non-Hispanic Black cohort of women with a prior spontaneous preterm birth, a nonoptimal cervicovaginal microbiota is associated with increased odds of recurrent spontaneous preterm birth. Adjustment for perceived stress may amplify associations between CST IV and recurrent spontaneous preterm birth. Identification of modifiable social or behavioral factors may unveil novel nonpharmacologic interventions to decrease recurrent spontaneous preterm birth among women with underlying biologic risk. KEY POINTS · CST IV, a nonoptimal microbiota, is associated with increased odds of recurrent spontaneous preterm birth.. · Adjustment for perceived stress amplified associations between CST IV and recurrent spontaneous preterm birth.. · Identification of modifiable psychosocial factors may unveil novel nonpharmacologic interventions to decrease recurrent preterm birth..
Collapse
Affiliation(s)
- Kristin D. Gerson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Clare Mccarthy
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jacques Ravel
- Department of Microbiology and Immunology, Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michal A. Elovitz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Heather H. Burris
- Department of Pediatrics, University of Pennsylvania, Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
16
|
The mediating role of adolescents' loneliness and social withdrawal in the association between maternal depressive symptoms and suicidality in adolescence: A 20-year population-based study. Dev Psychopathol 2021; 34:1045-1053. [PMID: 33487191 DOI: 10.1017/s0954579420001753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We examined whether adolescents' loneliness and social withdrawal mediated the association between maternal depressive symptoms and adolescent suicidality. Secondary analyses on the Québec Longitudinal Study of Child Development data were conducted (n = 1,623). Each mother completed the Centre for Epidemiologic Studies Depression Scale (at child ages 5 months, 1.5, 3.5, 5, and 7 years). Adolescent's social withdrawal (adolescent, father, and teacher reported at 10, 12, and 13 years) and loneliness (adolescent reported at 10, 12, and 13 years), were assessed using items from the Social Behavior Questionnaire and the Loneliness and Social Satisfaction Questionnaire, respectively. Adolescents completed self-reports to assess suicidal thoughts and attempts at 13, 15, 17, and 20 years. Children of mothers with higher levels of maternal depressive symptoms had an increased risk for suicidality (OR = 1.15, 95% CI: 1.03-1.28). Loneliness explained 16% of the total effect of maternal depressive symptoms on adolescent suicidality (indirect effect OR = 1.02, 95% CI: 1.00-1.04). There was no indirect effect of maternal depressive symptoms on adolescent suicidal outcomes via social withdrawal (indirect effect OR = 1.00, 95% CI: 0.99-1.02). Interventions that target loneliness may be beneficial for decreasing the risk for suicidality among adolescents of mothers with depressive symptoms.
Collapse
|
17
|
Real-time Assessment of the Development and Function of the Placenta Across Gestation to Support Therapeutics in Pregnancy. Clin Ther 2020; 43:279-286. [PMID: 33246660 DOI: 10.1016/j.clinthera.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 12/19/2022]
Abstract
The placenta is vital to the health and development of the fetus, serving to deliver oxygen and nutrients, facilitate the removal of waste products, and provide a barrier to pathogens and other harmful substances present in the maternal circulation. When these processes fail to operate normally, they can lead to complications of pregnancy such as preeclampsia or fetal growth restriction. The development of novel therapeutics for the mother, fetus, or placenta requires a mechanistic understanding of the development and functions of the placenta. For the obstetric clinician, being able to monitor the placenta throughout the pregnancy and to measure the impact of any treatment modality on the mother and the developing fetus are essential for providing the best possible care. The Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health has been a longtime supporter of research on the placenta. In 2014, the Human Placenta Project was initiated to help to drive an understanding of the biology of the human placenta and to facilitate the development of novel tools and approaches to allow for safe, noninvasive, real-time assessment of the placenta across pregnancy. Those efforts, along with others from around the globe, are showing promise. Although not yet ready for clinical application, these advances are moving the field forward and are certain to have a tremendous impact on the development and assessment of therapeutics designed for treating conditions of pregnancy.
Collapse
|
18
|
Voltas N, Arija V, Hernández-Martínez C, Nappi L, Cibelli G, Basora J, Canals J. Perinatal emotional states: a comparative study between two cohorts recruited in a Mediterranean environment. Women Health 2020; 61:221-234. [PMID: 33213300 DOI: 10.1080/03630242.2020.1847749] [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: 10/23/2022]
Abstract
Experiencing negative emotional states during pregnancy has been linked to adverse outcomes for mother and offspring. Our study aims were to compare the perinatal emotional states and obstetrical variables between pregnant women recruited in Spain (n = 202) and Italy (n = 103), and to investigate prenatal anxiety related factors. The study had two phases. In the 1st phase (3rd trimester of pregnancy), prenatal anxiety was assessed using the State-Trait Anxiety Inventory (STAI); other prenatal and sociodemographic variables were also collected. In the 2nd phase (40 days postpartum), the STAI and the Edinburgh Postnatal Depression Scale were administered. Compared to the Spanish sample, the Italian sample presented higher STAI state and STAI factor 1 mean scores (22.5 vs. 18.6 and 10.0 vs. 7.2), shorter gestations (mean gestation weeks: 39.1 vs. 39.8), more unplanned pregnancies (31.1% vs. 16.4%), and more cesareans deliveries (42.5% vs. 16.0%). Low socioeconomic levels, younger ages, previous miscarriages and unplanned pregnancies were related to prenatal anxiety. Postpartum depression rates was 31.3% and there were no differences between countries. Our results suggested that it may be interesting in both countries to create a prenatal monitoring protocol that attaches more importance to emotional wellbeing both during pregnancy and in the long term.
Collapse
Affiliation(s)
- Núria Voltas
- Research Center for Behavioral Assessment (CRAMC), Department of Psychology, Universitat Rovira I Virgili, Tarragona, Spain.,Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira I Virgili, Spain
| | - Victoria Arija
- Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira I Virgili, Spain.,Nutrition and Public Health Unit, Universitat Rovira I Virgili, Reus, Spain
| | - Carmen Hernández-Martínez
- Research Center for Behavioral Assessment (CRAMC), Department of Psychology, Universitat Rovira I Virgili, Tarragona, Spain.,Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira I Virgili, Spain
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Giuseppe Cibelli
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Josep Basora
- Institut d'Investigació en Atenció Primària Jordi Gol, Tarragona, Spain
| | - Josefa Canals
- Research Center for Behavioral Assessment (CRAMC), Department of Psychology, Universitat Rovira I Virgili, Tarragona, Spain.,Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira I Virgili, Spain
| |
Collapse
|
19
|
Effects of Tobacco Consumption and Anxiety or Depression during Pregnancy on Maternal and Neonatal Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218138. [PMID: 33158085 PMCID: PMC7663341 DOI: 10.3390/ijerph17218138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 11/24/2022]
Abstract
This study analyzed the possible interaction effects between tobacco consumption and anxiety or depression during pregnancy on maternal and neonatal health. We recruited a sample of 807 pregnant Spanish women from public healthcare services. Women completed a questionnaire on sociodemographic variables, health status and tobacco consumption (continuous, quitting or no consumption) in the first and third trimester of pregnancy and at 2 months postpartum, and self-reported measures of anxiety and depression in the first trimester. Abstinence of tobacco consumption was verified through biochemical measurements. Interaction effects between tobacco consumption and anxiety were found for delivery (p < 0.001), neonatal health complications (p = 0.026) and gestational age at birth (p = 0.029). Interaction effects between tobacco consumption and depression were found for pregnancy (p = 0.032), delivery complications (p < 0.001) and weeks of gestation at birth (p = 0.031). This study suggests that there are different kinds of interaction effects between tobacco consumption and anxiety or depression. Smokers with high anxiety presented more delivery complications compared to quitters and non-smokers with high anxiety. There is a cumulative effect of anxiety on the effects of tobacco consumption on maternal health. The results highlighted the beneficial impact of quitting smoking during pregnancy to reduce the risk of suffering anxiety, depression and health complications.
Collapse
|
20
|
The effect of relaxation exercises training on pregnancy-related anxiety after perinatal loss: A pilot randomized control trial✰. Explore (NY) 2020; 18:44-50. [DOI: 10.1016/j.explore.2020.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/12/2020] [Accepted: 11/15/2020] [Indexed: 11/18/2022]
|
21
|
Atif N, Nazir H, Zafar S, Chaudhri R, Atiq M, Mullany LC, Rowther AA, Malik A, Surkan PJ, Rahman A. Development of a Psychological Intervention to Address Anxiety During Pregnancy in a Low-Income Country. Front Psychiatry 2020; 10:927. [PMID: 31998151 PMCID: PMC6967413 DOI: 10.3389/fpsyt.2019.00927] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/21/2019] [Indexed: 12/21/2022] Open
Abstract
Background: One in five women suffer from anxiety during pregnancy. Untreated anxiety is a risk factor for postnatal depression and is associated with adverse birth outcomes. Despite the high prevalence of prenatal anxiety in low- and middle-income countries (LMICs), efforts to develop and evaluate context-specific interventions in these settings are lacking. We aimed to develop a culturally appropriate, feasible, and acceptable psychological intervention for perinatal anxiety in the context of a low-income population in Pakistan. Methods: We conducted this research in Rawalpindi District at the Obstetrics Department of the Holy Family Hospital, Rawalpindi Medical University a government facility catering to a mixture of low-income urban, peri-urban, and rural populations. We used a mixture of research methods to: a) investigate the clinical, cultural, and health-service delivery context of perinatal anxiety; b) select an evidence-based approach that suited the population and health-delivery system; c) develop an intervention with extensive reference documentation/manuals; and d) examine issues involved in its implementation. Qualitative data were collected through in-depth interviews and focus group discussions, and analyzed using framework analysis. Results: Informed by the qualitative findings and review of existing evidence-based practices, we developed the "Happy Mother, Healthy Baby" intervention, which was based on principles of cognitive behavior therapy. Its evidence-based elements included: developing an empathetic relationship, challenging thoughts, behavior activation, problem solving, and involving family. These elements were applied using a three-step approach: 1) learning to identify unhealthy or unhelpful thinking and behavior; 2) learning to replace unhealthy or unhelpful thinking and behavior with helpful thinking and behavior; and 3) practicing thinking and acting healthy. Delivered by non-specialist providers, the intervention used culturally appropriate illustrations and examples of healthy activities to set tasks in collaboration with the women to encourage engagement in helpful behaviors. Feedback from the non-specialist providers indicated that the intervention was acceptable, feasible, and perceived to be helpful by the women receiving it. Conclusion: This new psychosocial intervention for perinatal anxiety, based on principles of cognitive behavior therapy and delivered by non-specialists, has the potential to address this important but neglected condition in LMICs.
Collapse
Affiliation(s)
- Najia Atif
- Human Development Research Foundation, Gujar Khan, Pakistan
| | - Huma Nazir
- Human Development Research Foundation, Gujar Khan, Pakistan
| | - Shamsa Zafar
- Human Development Research Foundation, Gujar Khan, Pakistan
- Department of Gynecology and Obstetrics, Fazaia Medical College, Islamabad, Pakistan
| | - Rizwana Chaudhri
- Holy Family Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Maria Atiq
- Human Development Research Foundation, Gujar Khan, Pakistan
| | - Luke C. Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Armaan A. Rowther
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Abid Malik
- Human Development Research Foundation, Gujar Khan, Pakistan
| | - Pamela J. Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Atif Rahman
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
22
|
Stanhiser J, Steiner AZ. Psychosocial Aspects of Fertility and Assisted Reproductive Technology. Obstet Gynecol Clin North Am 2019; 45:563-574. [PMID: 30092929 DOI: 10.1016/j.ogc.2018.04.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Psychosocial aspects of fertility, infertility, and assisted reproductive technology (ART) can significantly impact patients' sense of self-identity and personal agency, mental well-being, sexual and marital relationships, reproductive efficiency, compliance with treatment, and pregnancy outcomes. Research is needed to understand how stress, anxiety, depression, mood disorders, and psychotropic medications impact fertility and infertility treatment. The psychosocial implications of ART on our society include a shift toward older maternal age at conception, the complexities of third-party reproduction, and consideration for the psychological and socioeconomic barriers to receiving care. Clinicians must understand, screen for, and identify couples struggling with the psychological and social aspects of fertility and ART.
Collapse
Affiliation(s)
- Jamie Stanhiser
- Reproductive Endocrinology and Infertility, University of North Carolina, Chapel Hill, NC, USA.
| | - Anne Z Steiner
- Duke University Hospital, 2301 Erwin Road, Durham, NC 27710, USA
| |
Collapse
|
23
|
Reardon DC. The abortion and mental health controversy: A comprehensive literature review of common ground agreements, disagreements, actionable recommendations, and research opportunities. SAGE Open Med 2018; 6:2050312118807624. [PMID: 30397472 PMCID: PMC6207970 DOI: 10.1177/2050312118807624] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/26/2018] [Indexed: 12/26/2022] Open
Abstract
The abortion and mental health controversy is driven by two different perspectives regarding how best to interpret accepted facts. When interpreting the data, abortion and mental health proponents are inclined to emphasize risks associated with abortion, whereas abortion and mental health minimalists emphasize pre-existing risk factors as the primary explanation for the correlations with more negative outcomes. Still, both sides agree that (a) abortion is consistently associated with elevated rates of mental illness compared to women without a history of abortion; (b) the abortion experience directly contributes to mental health problems for at least some women; (c) there are risk factors, such as pre-existing mental illness, that identify women at greatest risk of mental health problems after an abortion; and (d) it is impossible to conduct research in this field in a manner that can definitively identify the extent to which any mental illnesses following abortion can be reliably attributed to abortion in and of itself. The areas of disagreement, which are more nuanced, are addressed at length. Obstacles in the way of research and further consensus include (a) multiple pathways for abortion and mental health risks, (b) concurrent positive and negative reactions, (c) indeterminate time frames and degrees of reactions, (d) poorly defined terms, (e) multiple factors of causation, and (f) inherent preconceptions based on ideology and disproportionate exposure to different types of women. Recommendations for collaboration include (a) mixed research teams, (b) co-design of national longitudinal prospective studies accessible to any researcher, (c) better adherence to data sharing and re-analysis standards, and (d) attention to a broader list of research questions.
Collapse
|
24
|
Emergency department use during pregnancy: a prospective observational study in a single center institution. Arch Gynecol Obstet 2018; 297:1131-1135. [DOI: 10.1007/s00404-018-4684-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 01/23/2018] [Indexed: 10/18/2022]
|