Mood state at the beginning of the pregnancy and its influence on obstetric and perinatal outcomes

Validation of the anxiety subscale of the Spanish version of the Edinburgh Postnatal Depression Scale (EPDS-A)

Introduction

There is a need to implement routine perinatal mental health screening in Spain. Therefore, it is necessary to systematise the detection of depressive and anxious symptoms in pregnancy and postpartum using the same instrument. The Edinburgh Postnatal Stress Depression Scale (EPDS) is frequently used as a rapid, effective and cross-culturally validated screening tool for perinatal depression. In several countries, an Anxiety subscale, the EPDS-A, was identified within the EPDS. Although the factorial structure of the EPDS has been investigated in Spanish population, the EPDS-A has not yet been validated. This study aimed to validate the EPDS-A as a measure of perinatal anxiety in Spanish population.

Methods

161 women were evaluated with the EPDS and the State-Trait Anxiety Inventory (STAI) during pregnancy and postpartum. Confirmatory factor analysis (CFA) was used to confirm the trifactorial structure of the EPDS, comprising the dimensions of Depression, Anhedonia and Anxiety. Likewise, the invariance of the trifactorial model between pregnancy and postpartum was tested. Finally, the correlations between the EPDS-A and the STAI subscales (State Anxiety and Trait Anxiety) were calculated.

Results

The Exploratory factor analysis (EFA) driven three-factor structure of the EPDS, consisting of an Anhedonia factor (Items 1, 2, and 10), an Anxiety factor (Items 3, 4, 5, and 6) and a Depression factor (Items 7, 8, and 9), was the best measurement model for the current data compared to the alternative model tested [χ2 = 34.592, df = 32, p = 0.34; χ2/df = 1.08; RMSEA = 0.023, 90% Confidence Interval [CI] [0.000, 0.064], CFI = 0.996, GFI = 0.960]. The model's invariance between pregnant and postpartum women was confirmed. The existence of an Anxiety subscale within the EPDS was also confirmed. The scores obtained with the EPDS-A correlated moderately with scores on both subscales of the STAI during pregnancy and after delivery. Using the STAI as a criterion and prioritising the instrument's sensitivity, a cut-off point of 4 points was established for the EPDS-A.

Conclusion

Our results confirm the trifactorial structure of the EPDS in Spanish population. The Anxiety subscale was validated for routine perinatal mental health screening.

Happiness and associated factors amongst pregnant women in the United Arab Emirates: The Mutaba'ah Study

OBJECTIVE

Prenatal happiness and life satisfaction research are often over-shadowed by other pregnancy and birth outcomes. This analysis investigated the level of, and factors associated with happiness amongst pregnant women in the United Arab Emirates.

METHODS

Baseline cross-sectional data was analyzed from the Mutaba'ah Study, a large population-based prospective cohort study in the UAE. This analysis included all expectant mothers who completed the baseline self-administered questionnaire about sociodemographic and pregnancy-related information between May 2017 and July 2021. Happiness was assessed on a 10-point scale (1 = very unhappy; 10 = very happy). Regression models were used to evaluate the association between various factors and happiness.

RESULTS

Overall, 9,350 pregnant women were included, and the majority (60.9%) reported a happiness score of ≥8 (median). Higher levels of social support, planned pregnancies and primi-gravidity were independently associated with higher odds of being happier; adjusted odds ratio (aOR (95% CI): 2.02 (1.71-2.38), 1.34 (1.22-1.47), and 1.41 (1.23-1.60), respectively. Women anxious about childbirth had lower odds of being happier (aOR: 0.58 (0.52-0.64).

CONCLUSION

Self-reported happiness levels were high among pregnant women in the UAE. Health services enhancing social support and promoting well-being during pregnancy and childbirth may ensure continued happiness during pregnancy in the UAE.

Psychological factors and coping strategies in pregnancies complicated by hypertension: A cluster-analytic approach

BACKGROUND

Hypertensive disorders are important causes of maternal and perinatal morbidity and death. Considering the role of both physical and psychological factors in pregnancies complicated by hypertension, the aim of this study is to examine psychological factors and coping strategies in pregnancies complicated by hypertension.

METHODS

Cross-sectional study. A sample of 552 pregnant women, 343 with pregnancies complicated by hypertension, were assessed in terms of depression, anxiety, stress and coping.

RESULTS

The hypertensive group had higher scores of depression, stress and anxiety than the control one. Coping strategies were different between hypertensive and control groups (except for confrontive and self-reliant coping styles). When splitting up the hypertensive group into gestational hypertension, chronic hypertension and preeclampsia syndrome, differences between this new classification reached the statistical level. Our data suggests that women with preeclampsia have more symptoms of depression and worse coping strategies - they are less optimistic and more fatalistic. However, after a cluster analysis, two different subgroups of hypertensive women were found: one with worst coping strategies and more vulnerability to negative affective states and another with better coping and more resilient to mental health problems.

LIMITATIONS

Data were cross-sectional. We excluded women with some comorbidities, such as a diagnosis of kidney disease, diabetes or fetal malformation.

CONCLUSIONS

It is important to consider distinct profiles of pregnant women, in order to be able to better understand the peculiarities of mental health and coping during the gestation, especially in pregnancies complicated by hypertension.

Three or less? Decision making for or against selective reduction and psychological outcome in forty women with a triplet pregnancy

OBJECTIVES

The aim of the study was to investigate decision making for or against multifetal pregnancy reduction (MFPR) and psychological outcome in women with a triplet pregnancy.

METHODS

We investigated medical and sociodemographic variables and characteristics of the decision process for or against MFPR in forty women with triplet pregnancies who had either undergone MFPR (MFPR-group: N = 10) or had delivered triplets (triplet-group: N = 30). Moreover, emotional experiences of the reduction procedure were assessed. Psychological outcome was measured using the Beck Depression inventory (BDI) and the 36-Item Short Form Health Survey (SF-36).

RESULTS

Women of the MFPR-group had a higher gestational age at delivery (p = 0.001), shorter NICU stay (p = 0.001), higher educational level (p = 0.010), more frequently utilized psychological counseling during the decision process (p = 0.016), rated their gynecologist as more helpful for the decision (p = 0.045), required more time for their decision (p = 0.016), and were more likely to be in paid employment at follow-up (p = 0.041) than women of the triplet-group. MFPR was experienced as stressful (90%) or terrifying (10%). At 3.2 (±2.2) years after delivery, the vast majority of women in both groups were free from clinically relevant depression.

CONCLUSIONS

MFPR, though associated with emotional distress related to the procedure, results in a satisfactory psychological outcome in the majority of women. The decision for or against MFPR may be related to sociodemographic (such as educational) variables, which further supports the concept of framing in medical decision making. Having triplets most probably is associated with multiple (e.g. social or economic) consequences that may remain poorly investigated.

The Impact of Prenatal Depression in Patients of High Risk Pregnancy Clinic on Obstetric Outcomes

Prenatal depression is common and has been associated with risky maternal behavior, postpartum depression, and atypical child development. Still, its association with adverse perinatal outcomes is complex. The aim of our study was to look for this potential association in our region. The medical charts of women who were treated at our High-Risk Pregnancy Clinic and gave birth at our hospital were reviewed. The Edinburgh Postnatal Depression Scale (EPDS) was used to discover prenatal depression. Patients who reported past or current mental illness were excluded. We enrolled 202 women at a mean age of 32.81. Twin pregnancy was the most common reason for referral to the clinic (17.3%). The mean EPDS score was 4.63 (±4.66), with 15.3% scoring 10 or more. A significant correlation was found between the EPDS score and intrapartum fetal heart rate abnormalities, as well as with low birth weight. There were significant associations between the EPDS score and the maternal status of genetic disorder carrier, and the number of previous pregnancies, miscarriages, and elective termination of pregnancy. This study demonstrates a significant impact of the maternal psychological state on the obstetric outcome. In addition, we observed a significant association between maternal obstetric history, genetic data, and the risk of prenatal depression. Our study shows that completing the EPDS questionnaire is a very important part of the pregnancy follow-up, as it illuminates risk factors for prenatal depression and adverse perinatal outcomes.

Happiness in Pregnant African American Women: What Are the Biobehavioral Correlates?

The detrimental effects of prenatal stress on maternal-infant well-being have been well established and highlight increased concern for pregnant African American women. Research supports the notion that positive emotions may have a beneficial impact on the stress process and outcomes. However, the data have been largely restricted to non-African American pregnant women. This study's purpose was to examine potential relationships of both positive (happiness) and negative (stress, anxiety, and depressive symptoms) emotions and pro-inflammatory cytokines (interleukins-1β, -6, -8, -12, -17, tumor necrosis factor, and interferon-γ) in 72 pregnant African American women for a more complete picture of the stress process in this at-risk population. Results of this exploratory secondary data analysis show strong positive correlations between negative emotions and strong negative correlations between happiness and negative emotions. Interleukin-8 was positively correlated with negative emotions and negatively correlated with happiness. Results show mean ratings of negative emotions were higher than previously reported with more heterogeneous samples, while happiness ratings were in the moderate range. Findings suggest that pregnant African American women may experience higher stress and depressive symptoms than women in more heterogeneous samples. However, moderate levels of happiness might contribute to buffering the stress response.

Resiliencia en gestantes adolescentes del Caribe colombiano: evaluación con la escala de Wagnild y Young

Introducción: las adolescentes presentan cambios biológicos y reciben influencias sociales que las predisponen a quedar embarazadas a temprana edad. Objetivo: evaluar la resiliencia en un grupo de gestante adolescentes para estimar la frecuencia del NRB (nivel de resiliencia bajo) e identificar factores psicosociales asociados. Metodología: estudio transversal en gestantes adolescentes que acudieron a consulta prenatal en Cartagena, Colombia. Se aplicó un cuestionario de características sociodemográficas y escalas sobre resiliencia, familismo, religiosidad, espiritualidad, funcionalidad familiar, violencia de pareja, felicidad y autoestima. Se compararon dos grupos: NRB y NRAM (nivel de resiliencia alto/moderado). Se realizó una regresión logística multivariada para identificar los factores asociados al NRB. Resultados: se estudiaron 499 gestantes adolescentes con una edad promedio de 17 años. La mitad de ellas pertenecían a familias disfuncionales. Sesenta y cuatro (12,8 %) tuvieron un NRB con factores asociados como bajo familismo OR: 4,736 (IC 95 %: 2,673-8,392), baja autoestima OR: 4,257 (IC 95 %: 1,363-13,295), disfunción familiar OR: 3,902 (IC 95 %: 2,052-7,422), violencia de pareja OR: 2,689 (IC 95 %: 1,082-6,678), deficiente espiritualidad OR: 2,503 (IC 95 %: 1,461-4,287) y reducida felicidad OR: 2,063 (IC 95 %: 1,214-3,506). Conclusión: en una ciudad del Caribe colombiano, en trece de cada cien gestantes adolescentes que acudena consulta prenatal, se encontró NRB; disfunción familiar, violencia de pareja en el embarazo, deficiente perspectiva espiritual, reducida felicidad subjetiva, familismo y nivel de autoestima bajos se observaron asociados.

Determinants and underlying causes of frequent attendance in midwife-led care: an exploratory cross-sectional study

BACKGROUND

An adequate number of prenatal consultations is beneficial to the health of the mother and fetus. Guidelines recommend an average of 5-14 consultations. Daily practice, however, shows that some women attend the midwifery practice more frequently. This study examined factors associated with frequent attendance in midwifery-led care.

METHODS

We conducted a cross-sectional study in a large midwifery practice in the Netherlands among low-risk women who started prenatal care in 2015 and 2016. Based on Andersen's behavioral model, we collected data on potential determinants from the digital midwifery's practice database. Prenatal healthcare utilization was measured by a revised version of the Kotelchuck Index, which measures a combination of care entry and numbers of visits. Logistic regression models were fitted to estimate the likelihood of frequent attendance compared to the recommended number of visits, adjusted for all relevant factors. Separate models were fitted on the non-referred and the referred group of obstetric-led care, as referral was found to be an effect modifier.

RESULTS

The prevalence of frequent attendance was 23% (243/1053), mainly caused by worries and/or vague complaints (44%; 106/243). Among non-referred women, 53% (560/1053), frequent attendance was associated with consultation with an obstetrician (OR = 3.99 (2.35-6.77)) and exposure to sexual violence (OR = 2.17 (1.11-4.24)). Among the referred participants, 47% (493/1053), frequent attendance was associated with a consultation with an obstetrician (OR = 2.75 (1.66-4.57)), psychosocial problems in the past or present (OR = 1.85 (1.02-3.35) or OR = 2.99 (1.43-6.25)), overweight (OR = 1.88 (1.09-3.24)), and deprived area (OR = 0.50 (0.27-0.92)).

CONCLUSION

Our exploratory study indicates that the determinants of frequent attendance in midwifery-led care differs between non-referred and referred women. Underlying causes for frequent attendance was mainly because of non-medical reasons.

IMPLICATION FOR PRACTICE

A trustful midwife-client relationship is known to be needed for clients such as frequent attenders to share more detailed, personal stories in case of vague complaints or worries, which is necessary to identify their implicit needs.

Correlates for state and trait anxiety in a multicultural sample of Turkish and Spanish women at first trimester of pregnancy

OBJECTIVE

The main objective of this research was to assess the potential influence of cultural factors on the anxiety levels of a multicultural sample of Spanish and Turkish pregnant women at the beginning of the pregnancy.

METHODS

Between October and December 2017 a total of 250 Turkish and 264 Spanish pregnant women attending their first pregnancy medical check-up between 10 and 12 weeks of pregnancy in three different cities, Istanbul, Antalya and Malaga, were recruited for study. These women completed a questionnaire that included the Turkish or Spanish validated of the state-trait anxiety Inventory, and a series of questions related to health status, general mood, and sociodemographic variables.

RESULTS

The mean value for State Anxiety was 47.1 [16-56] (SD 4.2), and mild, moderate and severe State Anxiety was observed in 56.8%, 14.7% and 20.5% of participants, respectively. Mean value for trait anxiety was 46.9 [34-89] (SD 4.6) and 31.4%, 19.7% and 20.2% of participants scored for mild, moderate and severe anxiety respectively. Anxiety scores were significantly higher among Turkish women. In the whole sample, religion, working status, pregnancy planning and perceived partner´s support predicted anxiety at first trimester of pregnancy. Social support and educational level were the most important predictive variables in the Spanish subgroup, while religion, the number of living children and the lack of husband´s support were among Turkish pregnant women.

CONCLUSION

Our results confirm the existence of a high prevalence of women´s anxiety at the beginning of the pregnancy and some differences between Turkish and Spanish pregnant women have been observed. We have confirmed that some cultural features like family structure (having more children and cohabitants), the Islamic religion or the lack of perceived partner´s support became the most important vulnerability elements.

Cultural factors influencing antenatal depression: A cross-sectional study in a cohort of Turkish and Spanish women at the beginning of the pregnancy

BACKGROUND

Depression is the most frequent mental disorder during pregnancy, and its prevalence is at least as high as that of postnatal depression. Differences between Western and Eastern countries may exist according to cultural and educational factors.

OBJECTIVE

to determine the influence of social and cultural factors on the mood state of a multicultural sample of 514 Turkish and Spanish pregnant women at the beginning of the pregnancy.

METHODS

Between October and December 2017 250 Turkish and 264 Spanish pregnant women attending their first pregnancy medical check-up between 10 and 12 weeks of pregnancy were recruited (264 in Málaga, 102 in Istanbul and 148 in Antalya). These women completed a questionnaire that included the Turkish or Spanish validated versions of the Edinburg Postnatal Depression Scale (EDS) and a series of questions related to health status, general mood, and sociodemographic variables.

RESULTS

Turkish women scored significantly higher with a mean value of 12.1 (SD 4.2) against 7.6 (SD 4.3) of Spanish women. Coping strategies and matters of women´s concern were also different. A total of 9.1% of Spanish and 30% of Turkish scored over cut-off point of 13. We found differences in EDS scores regarding the type of work, working status, and educational level. Family structure and perceived support were identified as specific risk factors for antenatal depression (AD). The multivariate regression model showed that best predictor variables for EDS score in the global sample were the country of recruitment, the number of living children, the pregnancy planning and the perceived partner´s support.

CONCLUSIONS

Our results confirm the existence of important differences in AD prevalence between Turkish (30.0%) and Spanish (9.9%) pregnant women. Some sociocultural features like having more children, unplanned pregnancies, or perceiving poor support from the partner, become important vulnerability factors.