Psychometric properties of the Prenatal Health Behavior Scale in mid- and late pregnancy

Psychosocial factors associated with health behaviors in pregnant women of advanced maternal age in Korea

Objectives

To determine the association between psychosocial factors and health-promoting and health-impairing behaviors in pregnant women of advanced maternal age (AMA) in Korea.

Design

A cross-sectional survey study.

Setting

Online survey.

Samples

A total of 217 pregnant women aged 35 and older agreed to participate in the study, with 207 participants completing the self-report questionnaires.

Methods

We collected self-reported data on demographic, obstetric, and psychosocial factors and prenatal health behaviors using standardized measures. We conducted a descriptive analysis of the collected data and a linear regression to identify significant associations with health-promoting and health-impairing behaviors.

Results

We found that maternal-fetal attachment (β = 0.43, p < 0.001) and "social atmosphere" of pregnancy stress (β = 0.13, p = 0.047) were positively associated with prenatal health-promoting behaviors. We found that artificial conception (β =-0.16, p = 0.011) was negatively associated with prenatal health-impairing behaviors and that multiparity (β = 0.23, p = 0.001) and "maternal role" of pregnancy stress (β = 0.27, p = 0.003) positively associated with prenatal health-impairing behaviors.

Conclusion

Health-impairing behaviors of pregnant AMA women need assessment and the importance of health-promoting behaviors for maternal and infant health need reinforcing. We recommend pregnancy stress assessments at prenatal checkups and stress relief interventions that consider cultural differences and contexts rather than standardized interventions.

Adaptation of Screening Tools for Social Determinants of Health in Pregnancy: A Pilot Project

OBJECTIVES

Social determinants of health (SDOH) and stress during pregnancy may contribute to adverse pregnancy outcomes. The objective of this in the field pilot project was to develop a comprehensive screening tool by combining existing validated screeners. Additionally, implement use of this tool within routine prenatal visits and assess feasibility.

METHODS

Pregnant patients accessing prenatal care at a single site of an urban Federally Qualified Health Center were recruited during prenatal visits to complete a Social Determinants of Health in Pregnancy Tool (SIPT). SIPT combines a series of questions from existing and well-validated tools and consists of five domains: (1) perceived stress, (2) relationship and family stress, (3) domestic violence, (4) substance abuse, and (5) financial stress.

RESULTS

Between April 2018 and March 2019, 135 pregnant participants completed SIPT. Ninety-one percent of patients scored positive on at least one screener, 54% to three or more screeners.

CONCLUSIONS

Despite guidelines to screen for SDOH during pregnancy there is no universal tool. Our pilot project demonstrated the concurrent use of adapted screening tools where participants reported at least one area of potential stress, and that linking to resources at the time of a visit is plausible. Future work should examine if screening and point of care linkages of services improves maternal child outcomes.

Expectant parents' emotions evoked by pregnancy: A longitudinal dyadic analysis of couples in the Swedish Pregnancy Panel

RATIONALE

Holistic antenatal care requires knowledge of individuals' emotional response to pregnancy. Little is known about how a pregnant woman and her partner influence each other emotionally during a pregnancy.

OBJECTIVE

This study examines six discrete emotions that expectant couples experience during pregnancy, how these emotions change mid-to late-pregnancy, and whether the partners' emotional responses influence each other.

METHODS

A longitudinal dyadic study where pregnant women and their partners (1432 couples) rated the extent to which the pregnancy evoked joy, strength, security, worry, shame, and anger at pregnancy week 12-19, 22-24, and 36. Latent curve models with structured residuals identify levels of and change in these emotions over time, while accounting for between- and within-couple variance.

RESULTS

Pregnancy evoked mainly joy, strength, security, and worry, and lower levels of anger and shame. Pregnant women and partners felt similar levels of joy, strength, and security, but pregnant women felt more worry, shame, and anger. There was little to no mean-level change in all six measured emotions evoked by pregnancy (between-couple change), and no reciprocal effects between the partners (within-couple change).

CONCLUSIONS

Emotions in mid-pregnancy were also felt in late pregnancy. Furthermore, the pregnant woman and her partner have individual emotional trajectories. The results can assist healthcare professionals and researchers target interventions to expectant mothers and partners, specifically by understanding emotional response to pregnancy as a stable confound and by not approaching the couple as one emotional unit.

Health-promotion and health-harming behaviours in pregnant women: role of coping strategies, anxiety, and depression

There is a lack information on psychological predictors of health-promotion and health-harming behaviours during pregnancy. The study aimed to examine whether psychological factors including anxiety, depression, and coping strategies could predict the health-promotion and health-harm behaviours of pregnant women. In a cross-sectional study 200 pregnant women with singleton pregnancies, older than 18 years, and with at least 5 years of education were enrolled. The participants completed four questionnaires during their prenatal care appointments. The questionnaires included the prenatal health behaviour scale (PHBS), Revised Prenatal Coping Inventory (NU-PCI), Beck Depression Inventory (BDI-II), and State-Anxiety Inventory. The results revealed that planning-preparation coping was a strong positive independent variable associated with healthy behaviours (health-promoting behavioural/nutrition (β = 0.800, p = .001); health-promoting physical activity (β = 0.191, p = .049)). It was negatively associated with unhealthy behaviours (health-harming behavioural/nutrition (β = 0.290, p < .001) as well as health-harming physical activity (β = -0.290, p = .010)). Anxiety was significantly associated negatively with healthy behaviours. Depression was the strongest positive independent variable correlated with health-harming behavioural/nutrition (β = 0.290, p < .001). Finally, avoidance coping (β = 0.179, p = .037) was significant for health-harming physical activity.Impact statementWhat is already known on this subject? Previous studies have shown that there is a correlation between psychological factors and healthy behaviours of pregnant women.What do the results of this study add? The findings highlight the significant roles of coping strategies, anxiety, and depression for predicting healthy or unhealthy behaviours of pregnant women.What are the implications of these findings for clinical practice and/or further research? The findings implied that pregnant women who use more adaptive coping strategies, especially planning- preparing coping, reported lower levels of anxiety/depression and engaged more in healthy behaviours. The study also suggests that obstetricians and health care providers should pay more attention to the roles of coping strategies, especially planning-preparation and avoidance coping, anxiety, and depression in improving health-promotion/health-harming behaviours of pregnant women.

Adverse Perinatal Outcomes Predicted by Prenatal Maternal Stress Among U.S. Women at the COVID-19 Pandemic Onset

Background

High stress prenatally contributes to poor maternal and infant well-being. The coronavirus disease 2019 (COVID-19) pandemic has created substantial stress for pregnant women.

Purpose

To understand whether stress experienced by women pregnant at the beginning of the pandemic was associated with a greater prevalence of adverse perinatal outcomes.

Methods

Pregnant women across the USA aged ≥18 years old enrolled in a prospective cohort study during the pandemic onset (T1) in April–May 2020. This report focuses on the 1,367 participants who gave birth prior to July–August 2020 (T2). Hierarchical logistic regression models predicted preterm birth, small for gestational age infants, and unplanned operative delivery from T1 stress, sociodemographic, and medical factors.

Results

After controlling for sociodemographic and medical factors, preterm birth was predicted by high prenatal maternal stress, delivering an infant small for gestational age was predicted by interpersonal violence and by stress related to being unprepared for birth due to the pandemic, and unplanned cesarean or operative vaginal delivery was predicted by prenatal appointment alterations, experiencing a major stressful life event, and by stress related to being unprepared for birth due to the pandemic. Independent of these associations, African American women were more likely than other groups to deliver preterm.

Conclusion

Pregnant women who are experiencing high stress during the COVID-19 pandemic are at risk of poorer perinatal outcomes. A longitudinal investigation is critical to determine whether prenatal maternal stress and resulting outcomes have longer-term consequences for the health and well-being of children born in the midst of the current pandemic.

Prenatal stress, health, and health behaviours during the COVID-19 pandemic: An international survey

Background

Pregnant women’s stress, mental and physical health, and health behaviours can have important implications for maternal and child health outcomes.

Aim

To examine pregnant women’s levels of stress, mental and physical health, and health behaviours during the COVID-19 pandemic.

Methods

A cross-sectional survey was conducted online, with recruitment and data collection occurring between 16/6/20 and 17/7/20. Participants were pregnant women recruited via online pregnancy/parenting communities. Participants self-reported their levels of general stress, pregnancy-specific stress and COVID-19 related stress, mental and physical health, general health behaviours, and COVID-19 related health behaviours.

Findings

573 pregnant women participated in the survey. Participants were most commonly resident in the United States (42.6%, n = 243), Ireland (41.2%, n = 235) or the United Kingdom (10%, n = 57). The majority (80.0%, n = 457) were married and educated to degree level or above (79.3, n = 453). Pregnant women reported high levels of pregnancy-specific and COVID-19-related stress, and low levels of mental and physical health, during the pandemic. Encouragingly, pregnant women in this study generally reported high levels of adherence to public health advice and pregnancy health behaviours. Stress and general mental health outcomes were best predicted by well-being factors (including stress and social support). Health impairing behaviours (e.g. poor diet) were predicted by both well-being and demographic factors.

Discussion

Interventions targeting pregnancy- and pandemic-specific stress at the population level will be essential to support mental health and minimise adverse outcomes for women and children during the pandemic.

Development of the health behaviour scale for cancer patients (HBSCP), analysis of its factorial structure and evaluation of its psychometric properties

OBJECTIVE

The development and validation of a health behaviour scale for cancer patients (HBSCP).

METHODS

An 11-item scale was developed based on existing literature on health behaviour and cancer prevention and care. Identified dimensions include the following: nutrition and weight, physical activity, nicotine and alcohol use, stress, and adherence to medical health services. Experts rated the items in regard to content and wording. The scale was tested in two cross-sectional datasets of n = 4626 and n = 4558 newly diagnosed breast cancer patients in North Rhine-Westphalia, Germany. Psychometric properties were assessed (internal consistency, item discrimination, exploratory and confirmatory factor analysis). Correlations with physical functioning (EORTC QLQ-C30) and personality traits (Big Five Inventory) were computed (full assessment of construct validity was not possible).

RESULTS

A two-factor structure (1. adherence to medical health services; 2. Individual protective health behaviour) with nine items (item reduction due to findings in the factor analyses) with good item properties and reliability was identified. The scale showed significant associations with physical functioning and the personality traits of conscientiousness.

CONCLUSION

The HBSCP is an instrument with good psychometric properties that measures cancer patients' health behaviour. Healthcare providers and researchers can use the HBSCP in the context of health promotion and prevention.

The effect of individual counseling intervention on health practices in pregnancy: a randomized controlled trial

This research was carried out to determine the effect of individual counseling intervention on health practices in pregnancy. This research is a single-blind randomized controlled experimental and follow-up design. Population of the research consisted of 126 pregnant women in total, with 64 of them being in the training group and 64 being in the control group. The research data were collected by using a 'Pregnant Identifying Information Form' and 'Health Practices in Pregnancy Questionnaire (HPQ)'. In this research, it was found that there was no significant difference in total score average of the HPQ before the individual counseling training between the pregnant women in the training and control groups (P > 0.05). It was also determined that there was a statistically significant difference in total score average of the HPQ after the individual counseling training during the second trimester between the two groups (P < 0.05). It was determined that there was a statistically significant difference in total score average of the HPQ during the third trimester between two groups (P < 0.05). It has been determined that the training provided with individual counseling to pregnant women is an effective initiative in increasing the health practices of pregnant women.

Gendered racism and the sexual and reproductive health of Black and Latina Women

Objective: To understand health disparities, it is important to use an intersectional framework that examines unique experiences of oppression faced by particular groups due to their intersecting identities and social positions linked to societal structures. We focus on Black and Latina women and their experiences with 'gendered racism' - unique forms of oppression due to the intersection of race/ethnicity and gender - to foster understanding of disparities between Black and Latina versus White women in sexual and reproductive health outcomes in the U.S. Specifically, we focus on stereotype-related gendered racism (ongoing discrimination and stereotype threat based on historically-rooted stereotypes about Black and Latina women's sexuality and motherhood) and birth control-related mistrust (ongoing mistrust of the government and medical system related to birth control due to historical and current abuses).Design: We analyzed data from two survey studies with adult women in New York (Study 1: paper-and-pencil community data collection, N = 135, M_age= 43.35) and across the U.S. (Study 2: online data collection, N = 343, M_age= 29.49) who were currently pregnant or had at least one child and identified as Black, Latina, or White.Results: Black and Latina women reported greater frequency of and concern over stereotype-related gendered racism (F(3,131) = 17.90, p < .001 Study 1; F(3,339) = 22.23, p < .001 Study 2) and greater birth control-related mistrust (F(3,131) = 7.55, p < .001 Study 1; F(3,339) = 17.32, p < .001 Study 2) than White women did. In turn, stereotype-related gendered racism was positively associated with pregnancy-specific stress (ß = .40, p < .001 Study 1; ß = .33, p < .001 Study 2), and birth control-related mistrust was negatively associated with sexual relationship power (ß = -.19, p = .002 Study 2), which are factors known to contribute to birth outcomes and sexual risk, respectively.Conclusion: Findings suggest that gendered racism may play an important role in existing racial/ethnic disparities in women's sexual and reproductive health outcomes, and interventions addressing gendered racism at multiple levels are needed to promote health equity.

Conceptualization, measurement, and effects of pregnancy-specific stress: review of research using the original and revised Prenatal Distress Questionnaire

Pregnancy-specific stress (PSS) arises from the numerous changes that women experience during pregnancy and from their concerns about childbirth and the health of their offspring. Prolonged or elevated maternal stress heightens risk for poor fetal, infant, and child outcomes. The Prenatal Distress Questionnaire (PDQ) and its expanded successor, the revised Prenatal Distress Questionnaire (NuPDQ), were developed to assess PSS, but their psychometric properties and findings are not well-documented. We reviewed research using the PDQ (n = 45) or NuPDQ (n = 37). Results establish that PSS as measured by these instruments is common in pregnancy; PSS is associated with sociodemographic and obstetric characteristics, perceptions of pregnancy, health behaviors, maternal health, and birth outcomes. The NuPDQ is an especially appropriate tool to assess PSS, with demonstrated reliability and convergent, concurrent, and predictive validity. The ability to assess PSS in a reliable and valid manner is critical to advance research and improve maternal and child health.

Pregnancy-specific coping and changes in emotional distress from mid- to late pregnancy

Objective: To examine whether pregnancy-specific coping predicts changes in emotional distress from mid- to late pregnancy. Background: There is a need to identify ways of coping that reduce or elevate emotional distress in pregnant women as such distress increases the risk of adverse birth outcomes. Methods: 132 women receiving prenatal care from a university hospital midwifery practice were recruited prior to 25 weeks gestation (M = 19.58, SD = 5.14). The state anxiety version of the State-Trait Personality Inventory (STPI) and the Revised Prenatal Distress Questionnaire (NuPDQ) were administered in mid- (M = 25.7 weeks, SD = 4.55) and late (M = 33.4 weeks, SD = 4.18) pregnancy and the Revised Prenatal Coping Inventory (NuPCI) at the latter timepoint. Results: Factor analysis of the NuPCI identified five distinct, conceptually interpretable types of coping: Prayer/Spirituality, Receiving Social Support, Planning/Preparation, Positive Appraisal, and Avoidant Coping. Avoidant Coping was used least frequently and Positive Appraisal was used most. The STPI and NuPDQ were aggregated to create a measure of emotional distress. After controlling for mid-pregnancy distress, Avoidant Coping predicted greater emotional distress in late pregnancy (β = .18, R² = .61, p < .01) and Positive Appraisal predicted lower late pregnancy distress (β = -.15, R² = .60, p < .01). Conclusion: This is one of the first studies to demonstrate that specific ways of coping with stress during pregnancy predict changes in pregnant women's emotional distress. The NuPCI is a psychometrically sound self-report instrument to examine coping and its association with emotional distress.