1
|
Røhder K, Baumann MV, Karstoft KI, Schleicher I, George C, Harder S. The prenatal caregiving expectations questionnaire‐revised version: Factor structure, internal consistency, and initial construct validity. Infant Ment Health J 2024. [PMID: 38992864 DOI: 10.1002/imhj.22128] [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: 10/09/2023] [Revised: 04/12/2024] [Accepted: 06/13/2024] [Indexed: 07/13/2024]
Abstract
An efficient, multidimensional instrument is needed to screen non-optimal prenatal parental representations predictive of postnatal parenting behavior and child attachment. The present work aimed to revise and validate the Prenatal Caregiving Expectations Questionnaire-Revised (PCEQ-R). Survey data from two independent samples of pregnant, primarily Danish, women (N = 300/322) were collected to 1) test the factor structure and select items for a 20-item version, and 2) confirm the factor structure, examine internal consistency, and establish initial construct validity. Confirmatory factor analysis supported a three-factor model of helpless-dysregulated, anxious-hyperactivated, and avoidant-deactivated caregiving representations. Internal consistency was acceptable (α > .73). Construct validity analyses showed that higher helpless-dysregulated caregiving was associated with low maternal antenatal attachment quality (rs = -.36) and intensity (rs = -.11), increased risk of perinatal depression (rs = .37), and trait anxiety (rs = .37). Higher anxious-hyperactivated caregiving was associated with better maternal antenatal attachment quality (rs = .20) and higher intensity (rs = .26), while avoidant-deactivated caregiving was not associated with maternal antenatal attachment. These findings support the validity and multidimensional structure of the measure. The homogenous nature of the sample limits generalizability of results. Future studies should examine predictive validity of the PCEQ-R and include clinical samples.
Collapse
Affiliation(s)
- Katrine Røhder
- Department of Psychology, Center for Early Intervention and Family Studies, University of Copenhagen, Kobenhavn, Denmark
| | | | | | - Ida Schleicher
- Department of Psychology, University of Copenhagen, Kobenhavn, Denmark
| | - Carol George
- Psychology Department, Mills College at Northeastern University, Oakland, California, USA
| | - Susanne Harder
- Department of Psychology, University of Copenhagen, Kobenhavn, Denmark
| |
Collapse
|
2
|
Mazza M, Brisi C, Veneziani G, Lisci FM, Sessa I, Balocchi M, Rossi S, Di Stasio E, Marano G, Abate F, Anesini MB, Boggio G, Ciliberto M, De Masi V, Falsini C, Marzo EM, Avallone C, Serio A, Gonsalez Del Castillo A, Kotzalidis GD, Chieffo DPR, Lanzone A, Scambia G, Lai C, Sani G. A Network Analysis of Perinatal Depression, Anxiety, and Temperaments in Women in the First, Second, and Third Trimesters of Pregnancy. J Clin Med 2024; 13:3957. [PMID: 38999520 PMCID: PMC11242710 DOI: 10.3390/jcm13133957] [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: 06/02/2024] [Revised: 06/27/2024] [Accepted: 07/04/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: Although depression and anxiety are found to be affected by temperaments, little research has studied these relationships in pregnancy. The present study explored the associations among perinatal depression (PD), anxiety dimensions (state, trait, and generalized anxiety disorder (GAD)), and temperaments between women in the three trimesters of pregnancy through a network analysis approach. Moreover, differences in the severity of PD and anxiety between women in the three trimesters were evaluated. Methods: Women in first (N = 31), second (N = 184), and third (N = 54) trimesters of pregnancy were recruited in the present cross-sectional study. The network analysis included PD, anxiety dimensions, and temperaments. Three network models were estimated, and ANOVAs evaluated the differences in the severity of PD and anxiety, including trimesters as a between-subject factor. Results: PD and GAD were the nodes most strongly connected across the three groups. Cyclothymic, depressive, and anxious temperaments were most frequently associated with PD and GAD. Hyperthymic temperament was in the periphery of the three networks. Lastly, women in the first trimester had the highest severity of PD and GAD. Conclusions: PD and GAD showed the strongest associations. Anxiety dimensions had positive associations with PD and GAD, suggesting their role as possible risk factors. Temperaments were differently associated within the network between the three groups. Clinical interventions during pregnancy should target the central variables, considering their direct and indirect relationships.
Collapse
Affiliation(s)
- Marianna Mazza
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Caterina Brisi
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giorgio Veneziani
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via Degli Apuli 1, 00185 Rome, Italy
| | - Francesco Maria Lisci
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ilenia Sessa
- Unit of Clinical Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Marta Balocchi
- Unit of Clinical Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Sara Rossi
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Enrico Di Stasio
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics Research, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giuseppe Marano
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesca Abate
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Maria Benedetta Anesini
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gianluca Boggio
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Michele Ciliberto
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Valeria De Masi
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Cecilia Falsini
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ester Maria Marzo
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Carla Avallone
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Annamaria Serio
- Unit of Clinical Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | | | - Georgios Demetrios Kotzalidis
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
| | | | - Antonio Lanzone
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giovanni Scambia
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Carlo Lai
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via Degli Apuli 1, 00185 Rome, Italy
| | - Gabriele Sani
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| |
Collapse
|
3
|
Lähdepuro A, Räikkönen K, Pham H, Thompson-Felix T, Eid RS, O'Connor TG, Glover V, Lahti J, Heinonen K, Wolford E, Lahti-Pulkkinen M, O'Donnell KJ. Maternal social support during and after pregnancy and child cognitive ability: examining timing effects in two cohorts. Psychol Med 2024; 54:1661-1670. [PMID: 38087866 DOI: 10.1017/s0033291723003550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
BACKGROUND Maternal anxiety, depression, and stress during and after pregnancy are negatively associated with child cognitive development. However, the contribution of positive maternal experiences, such as social support, to child cognitive development has received less attention. Furthermore, how maternal experience of social support during specific developmental periods impacts child cognitive development is largely unknown. METHODS Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC; n = 5784) and the Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction study (PREDO; n = 420), we investigated the associations between maternal perceived social support during and after pregnancy and child's general cognitive ability at 8 years of age, assessed with the Wechsler Intelligence Scale for Children (WISC). Bayesian relevant life course modeling was used to investigate timing effects of maternal social support on child cognitive ability. RESULTS In both cohorts, higher maternal perceived social support during pregnancy was associated with higher performance on the WISC, independent of sociodemographic factors and concurrent maternal symptoms of depression and anxiety. In ALSPAC, pregnancy emerged as a sensitive period for the effects of perceived social support on child cognitive ability, with a stronger effect of social support during pregnancy than after pregnancy on child cognitive ability. CONCLUSIONS Our findings, supported from two prospective longitudinal cohorts, suggest a distinct role of maternal perceived social support during pregnancy for cognitive development in children. Our study suggests that interventions aimed at increasing maternal social support during pregnancy may be an important strategy for promoting maternal and child well-being.
Collapse
Affiliation(s)
- Anna Lähdepuro
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Yale Child Study Center, Yale University, New Haven, CT, USA
| | - Katri Räikkönen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Hung Pham
- Yale Child Study Center, Yale University, New Haven, CT, USA
| | | | - Rand S Eid
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Thomas G O'Connor
- Departments of Psychiatry, Neuroscience, Obstetrics and Gynecology, and Wynne Center for Family Research, University of Rochester, Rochester, NY, USA
| | | | - Jari Lahti
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Kati Heinonen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Psychology/Welfare Sciences, Tampere University, Tampere, Finland
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki and Oulu, Finland
| | - Elina Wolford
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Marius Lahti-Pulkkinen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki and Oulu, Finland
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Kieran J O'Donnell
- Yale Child Study Center, Yale University, New Haven, CT, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, New Haven, CT, USA
| |
Collapse
|
4
|
Vrantsidis DM, Klebanoff MA, Yeates KO, Murnan A, Fried P, Boone KM, Rausch J, Keim SA. Associations of prenatal stress with 5-year-old children's executive function in a low socioeconomic status population. Dev Psychopathol 2024:1-10. [PMID: 38706341 DOI: 10.1017/s0954579424000890] [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: 05/07/2024]
Abstract
Prenatal stress has a significant, but small, negative effect on children's executive function (EF) in middle and high socioeconomic status (SES) households. Importantly, rates and severity of prenatal stress are higher and protective factors are reduced in lower SES households, suggesting prenatal stress may be particularly detrimental for children's EF in this population. This study examined whether prenatal stress was linked to 5-year-old's EF in a predominantly low SES sample and child sex moderated this association, as males may be more vulnerable to adverse prenatal experiences. Participants were 132 mother-child dyads drawn from a prospective prenatal cohort. Mothers reported on their depression symptoms, trait anxiety, perceived stress, everyday discrimination, and sleep quality at enrollment and once each trimester, to form a composite prenatal stress measure. Children's EF was assessed at age 5 years using the parent-report Behavior Rating Inventory of Executive Function - Preschool (BRIEF-P) Global Executive Composite subscale and neuropsychological tasks completed by the children. Mixed models revealed higher prenatal stress was associated with lower BRIEF-P scores, indicating better EF, for females only. Higher prenatal stress was associated with lower performance on neuropsychological EF measures for both males and females. Results add to the limited evidence about prenatal stress effects on children's EF in low SES households.
Collapse
Affiliation(s)
| | - Mark A Klebanoff
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Aaron Murnan
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Peter Fried
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Kelly M Boone
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Joseph Rausch
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Sarah A Keim
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| |
Collapse
|
5
|
Clark HM, Hankin BL, Narayan AJ, Davis EP. Risk and resilience factors for psychopathology during pregnancy: An application of the Hierarchical Taxonomy of Psychopathology (HiTOP). Dev Psychopathol 2024; 36:545-561. [PMID: 36734236 PMCID: PMC10397364 DOI: 10.1017/s0954579422001390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Pregnancy is a time of increased vulnerability to psychopathology, yet limited work has investigated the extent to which variation in psychopathology during pregnancy is shared and unshared across syndromes and symptoms. Understanding the structure of psychopathology during pregnancy, including associations with childhood experiences, may elucidate risk and resilience factors that are transdiagnostic and/or specific to particular psychopathology phenotypes. Participants were 292 pregnant individuals assessed using multiple measures of psychopathology. Confirmatory factor analyses found evidence for a structure of psychopathology consistent with the Hierarchical Taxonomy of Psychopathology (HiTOP). A common transdiagnostic factor accounted for most variation in psychopathology, and both adverse and benevolent childhood experiences (ACEs and BCEs) were associated with this transdiagnostic factor. Furthermore, pregnancy-specific anxiety symptoms most closely reflected the dimension of Fear, which may suggest shared variation with manifestations of fear that are not pregnancy-specific. ACEs and BCEs also linked to specific prenatal psychopathology involving thought problems, detachment, and internalizing, externalizing, antagonistic, and antisocial behavior. These findings extend the dimensional and hierarchical HiTOP model to pregnant individuals and show how maternal childhood risk and resilience factors relate to common and specific forms of psychopathology during pregnancy as a period of enhanced vulnerability.
Collapse
Affiliation(s)
- Hannah M Clark
- Department of Psychology, Brandeis University, 415 South St., Waltham, MA, 02453, USA
| | - Benjamin L Hankin
- Department of Psychology, University of Illinois at Urbana-Champaign, 603 East Daniel St., Champaign, IL, 61820, USA
| | - Angela J Narayan
- Department of Psychology, University of Denver, 2155 South Race St., Denver, CO, 80208, USA
| | - Elysia Poggi Davis
- Department of Psychology, University of Denver, 2155 South Race St., Denver, CO, 80208, USA
- Department of Pediatrics, University of California, Irvine, 3028 Hewitt Hall, Irvine, CA, 92697, USA
| |
Collapse
|
6
|
Merced-Nieves FM, Lerman B, Colicino E, Bosquet Enlow M, Wright RO, Wright RJ. Maternal lifetime stress and psychological functioning in pregnancy is associated with preschoolers' temperament: Exploring effect modification by race and ethnicity. Neurotoxicol Teratol 2024; 103:107355. [PMID: 38719081 PMCID: PMC11156532 DOI: 10.1016/j.ntt.2024.107355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/02/2024] [Accepted: 05/03/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Psychosocial stress and psychopathology frequently co-occur, with patterns differing by race and ethnicity. We used statistical mixtures methodology to examine associations between prenatal stress and child temperament in N = 382 racially and ethnically diverse maternal-child dyads to disentangle associations among maternal stressful life events, maternal psychological functioning in pregnancy, childhood neurobehavior, and maternal race and ethnicity. METHODS This study utilized data from a longitudinal pregnancy cohort, PRogramming of Intergenerational Stress Mechanisms (PRISM). Mothers completed the Lifetime Stressor Checklist-Revised, Edinburgh Postnatal Depression Scale, and Spielberger State-Trait Anxiety Scale during pregnancy. When their children were 3-5 years of age, they completed the Children's Behavior Questionnaire, which yields three temperament dimensions: Negative Affectivity (NA), Effortful Control (EC), and Surgency (S). We used weighted quantile sum regression to derive a weighted maternal stress index encompassing lifetime stress and depression and anxiety symptoms and examined associations between the resulting stress index and child temperament. Differential contributions of individual stress domains by race and ethnicity also were examined. RESULTS Mothers self-identified as Black/Black Hispanic (46.1 %), non-Black Hispanic (31.9 %), or non-Hispanic White (22 %). A higher maternal stress index was significantly associated with increased child NA (β = 0.72 95 % CI = 0.35, 1.10). Lifetime stress was the strongest contributor among Hispanic (36.7 %) and White (17.8 %) mothers, whereas depressive symptoms in pregnancy was the strongest contributor among Black (16.7 %) mothers. CONCLUSION Prenatal stress was most strongly associated with negative affectivity in early childhood. Consideration of multiple stress measures as a mixture accounted for differential contributions of individual stress domains by maternal race and ethnicity. These findings may help elucidate the etiology of racial/ethnic disparities in childhood neurobehavior.
Collapse
Affiliation(s)
- Francheska M Merced-Nieves
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Climate Change, Environmental Health, and Exposomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Bonnie Lerman
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elena Colicino
- Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Climate Change, Environmental Health, and Exposomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michelle Bosquet Enlow
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Robert O Wright
- Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Climate Change, Environmental Health, and Exposomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rosalind J Wright
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Climate Change, Environmental Health, and Exposomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
7
|
Xu X, Buzzell GA, Bowers ME, Shuffrey LC, Leach SC, McSweeney M, Yoder L, Fifer WP, Myers MM, Elliott AJ, Fox NA, Morales S. Electrophysiological correlates of inhibitory control in children: Relations with prenatal maternal risk factors and child psychopathology. Dev Psychopathol 2024:1-14. [PMID: 38654404 DOI: 10.1017/s0954579424000816] [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: 04/25/2024]
Abstract
Inhibitory control plays an important role in children's cognitive and socioemotional development, including their psychopathology. It has been established that contextual factors such as socioeconomic status (SES) and parents' psychopathology are associated with children's inhibitory control. However, the relations between the neural correlates of inhibitory control and contextual factors have been rarely examined in longitudinal studies. In the present study, we used both event-related potential (ERP) components and time-frequency measures of inhibitory control to evaluate the neural pathways between contextual factors, including prenatal SES and maternal psychopathology, and children's behavioral and emotional problems in a large sample of children (N = 560; 51.75% females; Mage = 7.13 years; Rangeage = 4-11 years). Results showed that theta power, which was positively predicted by prenatal SES and was negatively related to children's externalizing problems, mediated the longitudinal and negative relation between them. ERP amplitudes and latencies did not mediate the longitudinal association between prenatal risk factors (i.e., prenatal SES and maternal psychopathology) and children's internalizing and externalizing problems. Our findings increase our understanding of the neural pathways linking early risk factors to children's psychopathology.
Collapse
Affiliation(s)
- Xiaoye Xu
- Department of Psychology, State University of New York at Cortland, Cortland, NY, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - George A Buzzell
- Department of Psychology, Florida International University, Miami, FL, USA
- Center for Children and Families, Miami, FL, USA
| | - Maureen E Bowers
- Department of Human Development and Quantitative Methodology, The University of Maryland at College Park, College Park, MD, USA
| | - Lauren C Shuffrey
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Stephanie C Leach
- Department of Human Development and Quantitative Methodology, The University of Maryland at College Park, College Park, MD, USA
| | - Marco McSweeney
- Department of Human Development and Quantitative Methodology, The University of Maryland at College Park, College Park, MD, USA
| | - Lydia Yoder
- Department of Human Development and Quantitative Methodology, The University of Maryland at College Park, College Park, MD, USA
| | - William P Fifer
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Michael M Myers
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Amy J Elliott
- Avera Research Institute, Sioux Falls, SD, USA
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, USA
| | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, The University of Maryland at College Park, College Park, MD, USA
| | - Santiago Morales
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
8
|
Padilha M, Ferreira ALL, Normando P, Schincaglia RM, Freire SR, Keller VN, Figueiredo ACC, Yin X, Brennan L, Kac G. Maternal serum amino acids and hydroxylated sphingomyelins at pregnancy are associated with anxiety symptoms during pregnancy and throughout the first year after delivery. J Affect Disord 2024; 351:579-587. [PMID: 38316261 DOI: 10.1016/j.jad.2024.01.227] [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: 09/20/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Studies suggest an interplay between maternal metabolome and mental health. OBJECTIVE We investigated the association of maternal serum metabolome at pregnancy with anxiety scores during pregnancy and throughout the first year postpartum. METHODS A prospective cohort of Brazilian women collected 119 serum metabolome at pregnancy (28-38 weeks) and anxiety scores measured by the State-Trait Anxiety Inventory (STAI) at pregnancy (n = 118), 1 (n = 83), 6 (n = 68), and 12 (n = 57) months postpartum. Targeted metabolomics quantified metabolites belonging to amino acids (AA), biogenic amines/amino acid-related compounds, acylcarnitines, lysophosphatidylcholines, diacyl phosphatidylcholines, alkyl:acyl phosphatidylcholines, non-hydroxylated and hydroxylated sphingomyelins [SM(OH)], and hexoses classes. Linear mixed-effect models were used to evaluate the association of metabolites and STAI scores. Hierarchical clustering and principal component analyses were employed to identify clusters and metabolites, which drove their main differences. Multiple comparison-adjusted p-values (q-value) ≤ 0.05 were considered significant. RESULTS AA (β = -1.44) and SM(OH) (β = -1.49) classes showed an association with STAI scores trajectory (q-value = 0.047). Two clusters were identified based on these classes. Women in cluster 2 had decreased AA and SM(OH) concentrations and higher STAI scores (worse symptoms) trajectory (β = 2.28; p-value = 0.041). Isoleucine, leucine, valine, SM(OH) 22:1, 22:2, and 24:1 drove the main differences between the clusters. LIMITATIONS The target semiquantitative metabolome analysis and small sample size limited our conclusions. CONCLUSIONS Our results suggest that AA and SM(OH) during pregnancy play a role in anxiety symptoms throughout the first year postpartum.
Collapse
Affiliation(s)
- Marina Padilha
- Department of Social and Applied Nutrition, Federal University of Rio de Janeiro, Josué de Castro Nutrition Institute, Rio de Janeiro, RJ, Brazil
| | - Ana Lorena Lima Ferreira
- Department of Social and Applied Nutrition, Federal University of Rio de Janeiro, Josué de Castro Nutrition Institute, Rio de Janeiro, RJ, Brazil
| | - Paula Normando
- Department of Social and Applied Nutrition, Federal University of Rio de Janeiro, Josué de Castro Nutrition Institute, Rio de Janeiro, RJ, Brazil
| | - Raquel Machado Schincaglia
- Department of Social and Applied Nutrition, Federal University of Rio de Janeiro, Josué de Castro Nutrition Institute, Rio de Janeiro, RJ, Brazil
| | - Samary Rosa Freire
- Department of Social and Applied Nutrition, Federal University of Rio de Janeiro, Josué de Castro Nutrition Institute, Rio de Janeiro, RJ, Brazil
| | - Victor Nahuel Keller
- Department of Social and Applied Nutrition, Federal University of Rio de Janeiro, Josué de Castro Nutrition Institute, Rio de Janeiro, RJ, Brazil
| | - Amanda Caroline Cunha Figueiredo
- Department of Social and Applied Nutrition, Federal University of Rio de Janeiro, Josué de Castro Nutrition Institute, Rio de Janeiro, RJ, Brazil
| | - Xiaofei Yin
- UCD School of Agriculture and Food Science, Conway Institute, UCD Institute of Food and Health, University College Dublin, Ireland
| | - Lorraine Brennan
- UCD School of Agriculture and Food Science, Conway Institute, UCD Institute of Food and Health, University College Dublin, Ireland
| | - Gilberto Kac
- Department of Social and Applied Nutrition, Federal University of Rio de Janeiro, Josué de Castro Nutrition Institute, Rio de Janeiro, RJ, Brazil.
| |
Collapse
|
9
|
Tan HS, Tan CW, Sultana R, Chen HY, Chua T, Rahman N, Gandhi M, Sia ATH, Sng BL. The association between epidural labour analgesia and postpartum depression: a randomised controlled trial. Anaesthesia 2024; 79:357-367. [PMID: 37990597 DOI: 10.1111/anae.16178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 11/23/2023]
Abstract
There is conflicting evidence regarding the association between epidural labour analgesia and risk of postpartum depression. Most previous studies were observational trials with limited ability to account for confounders. We aimed to determine if epidural analgesia was associated with a significant change in the incidence of postpartum depression in this randomised controlled trial. We enrolled women aged 21-50 years old with a singleton fetus ≥ 36 weeks gestation. Patients were advised regarding available labour analgesic modalities during enrolment (epidural block; intramuscular pethidine; nitrous oxide; or intravenous remifentanil). On request for analgesia, patients were offered the modality that they had been allocated randomly to first. Blinded investigators recorded patient and obstetric characteristics within 24 h of delivery and assessed for postpartum depression at 6-10 weeks following delivery using the Edinburgh Postnatal Depression Scale (score ≥ 13 considered positive for postpartum depression). The modified intention-to-treat population consisted of all patients who received any form of labour analgesia, while per-protocol consisted of patients who received their randomised modality as their first form of labour analgesia. Of 881 parturients allocated randomly (epidural n = 441, non-epidural n = 440), we analysed 773 (epidural n = 389, non-epidural n = 384); 62 (15.9%) of women allocated to epidural group developed postpartum depression compared with 65 (16.9%) women allocate to the non-epidural group. There were no significant differences in the incidence of postpartum depression between the two groups (adjusted risk difference (95%CI) 1.6 (-3.0-6.3%), p = 0.49). Similar results were obtained with per-protocol analysis (adjusted risk difference (95%CI) -1.0 (-8.3-6.3%), p = 0.79). We found no significant difference in the risk of postpartum depression between patients who received epidural labour analgesia and those who utilised non-epidural analgesic modalities.
Collapse
Affiliation(s)
- H S Tan
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore
- Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - C W Tan
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore
- Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - R Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - H Y Chen
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Paediatrics Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - T Chua
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Paediatrics Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - N Rahman
- Department of Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - M Gandhi
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
- Department of Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore
| | - A T H Sia
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore
- Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - B L Sng
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore
- Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
10
|
Hernandez A, Sania A, Bowers ME, Leach SC, McSweeney M, Yoder L, Fifer W, Elliott AJ, Shuffrey L, Rauh V, Him DA, Fox NA, Morales S. Examining the impact of prenatal maternal internalizing symptoms and socioeconomic status on children's frontal alpha asymmetry and psychopathology. Dev Psychobiol 2024; 66:e22476. [PMID: 38433442 DOI: 10.1002/dev.22476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/05/2024]
Abstract
Prenatal maternal internalizing psychopathology (depression and anxiety) and socioeconomic status (SES) have been independently associated with higher risk for internalizing and externalizing problems in children. However, the pathways behind these associations are not well understood. Numerous studies have linked greater right frontal alpha asymmetry to internalizing problems; however, findings have been mixed. Several studies have also linked maternal internalizing psychopathology to children's frontal alpha asymmetry. Additionally, emerging studies have linked SES to children's frontal alpha asymmetry. To date, only a limited number of studies have examined these associations within a longitudinal design, and the majority have utilized relatively small samples. The current preregistered study utilizes data from a large prospective study of young children (N = 415; Meanage = 7.27 years; Rangeage = 5-11 years) to examine the association between prenatal maternal internalizing symptoms, children's frontal alpha asymmetry, and behavior problems. Prenatal maternal internalizing symptoms did not predict children's frontal alpha asymmetry, and there was no association between frontal alpha asymmetry and behavior problems. However, mothers' internalizing symptoms during pregnancy predicted children's internalizing and externalizing outcomes. Non-preregistered analyses showed that lower prenatal maternal SES predicted greater child right frontal alpha asymmetry and internalizing problems. Additional non-preregistered analyses did not find evidence for frontal alpha asymmetry as a moderator of the relation between prenatal maternal internalizing psychopathology and SES to children's behavior problems. Future research should examine the impact of SES on children's frontal alpha asymmetry in high-risk samples.
Collapse
Affiliation(s)
- Alexis Hernandez
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - Ayesha Sania
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Maureen E Bowers
- Department of Human Development and Quantitative Methodology, University of Maryland - College Park, College Park, Maryland, USA
| | - Stephanie C Leach
- Department of Psychological & Brain Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Marco McSweeney
- Department of Human Development and Quantitative Methodology, University of Maryland - College Park, College Park, Maryland, USA
| | - Lydia Yoder
- Department of Human Development and Quantitative Methodology, University of Maryland - College Park, College Park, Maryland, USA
| | - William Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Amy J Elliott
- Avera Research Institute, Sioux Falls, South Dakota, USA
| | - Lauren Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Virginia Rauh
- Heilbrunn Department of Population and Family Health, Columbia University, New York, New York, USA
| | | | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland - College Park, College Park, Maryland, USA
| | - Santiago Morales
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
11
|
McKechnie AC, Elgersma KM, Ambrose MB, Sanchez Mejia AA, Shah KM, Iwaszko Wagner T, Trebilcock A, Hallock C. Nurse-guided Mobile Health Care Program to Reduce Emotional Distress Experienced by Parents of Infants Prenatally Diagnosed with Critical Congenital Heart Disease: A Pilot Study. PROGRESS IN PEDIATRIC CARDIOLOGY 2024; 72:101687. [PMID: 38130374 PMCID: PMC10732467 DOI: 10.1016/j.ppedcard.2023.101687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Background Following prenatal diagnosis of critical congenital heart disease (CCHD), parents encounter emotional distress while facing caregiving challenges. Supportive psycho-educational interventions using mobile health (mHealth) can make care more accessible. Objectives We tested a novel nurse-guided mHealth care program, Preparing Heart and Mind™ (PHM™), with the objectives of examining feasibility and estimating the effect of the intervention on parents' emotional distress. Methods This pilot study design randomized participants using a 2:1 intervention to control ratio. Analysis involved description of retention, and intervention attendance and engagement, and adjusted linear mixed models to estimate group differences in depressive (CES-D), anxiety (STAI-S), and traumatic stress (IES-r) symptoms. Results The sample included 55 parents (n=38 PHM™ group, n=17 control). Complete retention of 37 (67%) parents included 29 (76%) in the PHM™ group and 8 (47%) control. Most attrition was due to infant death (7 parents), transplant referral (2 parents), or postnatal diagnostic ineligibility (4 parents). For the PHM™ group, ≥96% of parents attended pre- and postnatal sessions and most (65%) messaged with the nurse. mHealth engagement was highest prenatally, with handling uncertainty the most viewed topic (average 94% pages viewed). In linear mixed models analyses, the PHM™ group had on average 4.84 points lower depression (95% CI: -10.68-1.04), 6.56 points lower anxiety (-14.04-0.92), and 6.28 points lower trauma (-14.44-1.88) scores by study end. Conclusion Findings suggest that a nurse-guided mHealth approach is feasible and may contribute to a clinically important reduction in parents' emotional distress.
Collapse
Affiliation(s)
- Anne Chevalier McKechnie
- University of Minnesota School of Nursing, Child and Family Health Cooperative, 6-138D Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA
| | - Kristin M Elgersma
- University of Minnesota School of Nursing, Child and Family Health Cooperative, 6-138D Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA
| | - Matthew B Ambrose
- University of Minnesota Medical School, Department of Pediatrics, 420 Delaware Street SE, Minneapolis, MN 55455
- M Health Fairview Maternal and Fetal Medicine Center, 606 24th Avenue South, Minneapolis, MN 55454
| | - Aura A Sanchez Mejia
- Baylor College of Medicine, Department of Pediatrics, 1 Baylor Plaza, Houston, TX 77030
- Texas Children's Hospital Maternal-Fetal Medicine, 6651 Main Street, Houston, TX 77030
| | - Kavisha M Shah
- University of Minnesota Medical School, Department of Pediatrics, 420 Delaware Street SE, Minneapolis, MN 55455
- M Health Fairview Maternal and Fetal Medicine Center, 606 24th Avenue South, Minneapolis, MN 55454
| | - Taylor Iwaszko Wagner
- University of Minnesota School of Nursing, Child and Family Health Cooperative, 6-138D Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA
| | - Anna Trebilcock
- University of Minnesota School of Nursing, Child and Family Health Cooperative, 6-138D Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA
| | - Carrie Hallock
- GetWell, 7700 Old Georgetown Rd., 4th Floor, Bethesda, MD 20814
| |
Collapse
|
12
|
Pineles BL, Vial M, Castro T, Ghorayeb T, Ajishegiri O, Sadek S, Pedroza C, Blackwell SC, Chauhan SP, Sibai BM. Ambulation for latency during expectant management of preterm prelabor rupture of membranes: a randomized controlled trial (AMBLE). Am J Obstet Gynecol MFM 2024; 6:101218. [PMID: 37944668 DOI: 10.1016/j.ajogmf.2023.101218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/24/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Individuals hospitalized with preterm prelabor rupture of membranes are often advised to limit their activity or adhere to bed rest. Some evidence suggests that greater activity is associated with longer latency and improved outcomes, but no high-quality evidence from a randomized controlled trial exists. OBJECTIVE This study aimed to evaluate whether encouragement to ambulate at least 2000 steps daily affects latency among individuals with preterm prelabor rupture of membranes compared with usual care. STUDY DESIGN This was a multisite unblinded, 2-arm randomized trial of individuals at 23 0/7 to 35 0/7 weeks of gestation undergoing inpatient expectant management of preterm prelabor rupture of membranes with planned delivery at least 7 days away. Each participant wore a Fitbit Inspire that tracked steps. The intervention arm was encouraged (verbal and Fitbit-based reminders) to reach a goal of 2000 steps per day. The usual-care arm was allowed ad libitum activity with no step goal or reminders. The primary outcome was latency (days) from randomization to delivery. Secondary analyses included composite neonatal and maternal clinical outcomes and maternal mental health survey results. Statistical analyses were conducted with an intent-to-treat approach under a Bayesian framework using neutral priors (a priori assumed 50:50 likelihood of longer latency in either arm). A total of 100 participants were required to have 80% power to demonstrate a 4-day difference in latency with 75% certainty (Bayesian probability). RESULTS Among 163 eligible individuals, 100 (61%) were randomized, and after loss to follow-up, 95 were analyzed. Gestational age at randomization was 29 3/7 weeks (interquartile range, 26 2/7 to 31 5/7) in the intervention arm and 27 4/7 weeks (interquartile range, 25 4/7 to 29 6/7) in the usual-care arm. Median step counts were 1690 per day in the intervention arm (interquartile range, 1031-2641) and 1338 per day in the usual-care arm (interquartile range, 784-1913). Median days of latency were 9 days in the intervention arm (interquartile range, 4-17) and 6 days in the usual-care arm (interquartile range, 2-14). The primary analysis indicated a 65% posterior probability that the intervention increased latency relative to usual care (posterior relative risk, 1.09; 95% credible interval, 0.70-1.71). The relative risk was 0.55 (95% credible interval, 0.32-0.82) for the composite neonatal adverse outcome, with 99% posterior probability of intervention benefit, and was 0.94 (95% credible interval, 0.72-1.20) for the composite maternal adverse outcome, with 70% posterior probability of intervention benefit. There was a 94% posterior probability of the intervention arm having a greater decrease in maternal stress score from baseline to before delivery compared with the usual-care arm (mean arm difference, 3.24 points [95% credible interval, -7.23 to 0.79]). Adjustment for gestational age at randomization had minimal impact on secondary outcome results. CONCLUSION Individuals with preterm prelabor rupture of membranes randomized to encouragement to ambulate had a longer latency to delivery and improved neonatal and mental health outcomes, with similar maternal clinical outcomes compared with usual care.
Collapse
Affiliation(s)
- Beth L Pineles
- Department of Obstetrics, Gynecology and Reproductive Sciences, John P. and Kathrine G. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX (Drs Pineles and Vial, Ms Castro, Dr Ghorayeb, Ms Ajishegiri, and Drs Sadek, Blackwell, Chauhan, and Sibai); Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Dr Pineles).
| | - Mallory Vial
- Department of Obstetrics, Gynecology and Reproductive Sciences, John P. and Kathrine G. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX (Drs Pineles and Vial, Ms Castro, Dr Ghorayeb, Ms Ajishegiri, and Drs Sadek, Blackwell, Chauhan, and Sibai)
| | - Tania Castro
- Department of Obstetrics, Gynecology and Reproductive Sciences, John P. and Kathrine G. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX (Drs Pineles and Vial, Ms Castro, Dr Ghorayeb, Ms Ajishegiri, and Drs Sadek, Blackwell, Chauhan, and Sibai)
| | - Tala Ghorayeb
- Department of Obstetrics, Gynecology and Reproductive Sciences, John P. and Kathrine G. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX (Drs Pineles and Vial, Ms Castro, Dr Ghorayeb, Ms Ajishegiri, and Drs Sadek, Blackwell, Chauhan, and Sibai)
| | - Oluwadare Ajishegiri
- Department of Obstetrics, Gynecology and Reproductive Sciences, John P. and Kathrine G. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX (Drs Pineles and Vial, Ms Castro, Dr Ghorayeb, Ms Ajishegiri, and Drs Sadek, Blackwell, Chauhan, and Sibai)
| | - Sandra Sadek
- Department of Obstetrics, Gynecology and Reproductive Sciences, John P. and Kathrine G. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX (Drs Pineles and Vial, Ms Castro, Dr Ghorayeb, Ms Ajishegiri, and Drs Sadek, Blackwell, Chauhan, and Sibai)
| | - Claudia Pedroza
- Department of Pediatrics, John P. and Kathrine G. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX (Dr Pedroza)
| | - Sean C Blackwell
- Department of Obstetrics, Gynecology and Reproductive Sciences, John P. and Kathrine G. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX (Drs Pineles and Vial, Ms Castro, Dr Ghorayeb, Ms Ajishegiri, and Drs Sadek, Blackwell, Chauhan, and Sibai)
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, John P. and Kathrine G. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX (Drs Pineles and Vial, Ms Castro, Dr Ghorayeb, Ms Ajishegiri, and Drs Sadek, Blackwell, Chauhan, and Sibai)
| | - Baha M Sibai
- Department of Obstetrics, Gynecology and Reproductive Sciences, John P. and Kathrine G. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX (Drs Pineles and Vial, Ms Castro, Dr Ghorayeb, Ms Ajishegiri, and Drs Sadek, Blackwell, Chauhan, and Sibai)
| |
Collapse
|
13
|
Ohene-Agyei P, Tran T, Harding JE, Crowther CA. Do glycaemic treatment targets affect the perinatal mental health status of women with gestational diabetes? - Data from the TARGET Trial. BMC Pregnancy Childbirth 2023; 23:869. [PMID: 38104076 PMCID: PMC10724999 DOI: 10.1186/s12884-023-06190-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus is associated with perinatal mental disorders. Effective management may reduce this risk, but there is little evidence on effects of different glycaemic treatment targets. We assessed whether tight glycaemic treatment targets compared with less-tight targets reduce the risk of poor mental health outcomes in women with gestational diabetes. METHODS This was a secondary analysis of data from women who consented to complete perinatal mental health questionnaires as participants in the TARGET Trial, a stepped-wedge cluster randomized trial in 10 hospitals in New Zealand. All hospitals initially used less tight glycaemic targets for management of gestational diabetes and were sequentially randomized, in clusters of two at 4-monthly intervals, to using tighter glycaemic targets. Data were collected from 414 participants on anxiety (6-item Spielberger State Anxiety scale), depression (Edinburgh Postnatal Depression Scale), and health-related quality of life (36-Item Short-Form General Health Survey) at the time of diagnosis (baseline), 36 weeks of gestation, and 6 months postpartum. The primary outcome was composite poor mental health (any of anxiety, vulnerability to depression, or poor mental health-related quality of life). Generalized linear mixed models were used to determine the main treatment effect with 95% confidence intervals using an intention-to-treat approach. RESULTS We found no differences between randomised glycaemic target groups in the primary outcome at 36 weeks' (relative risk (RR): 1.07; 95% confidence interval 0.58, 1.95) and 6 months postpartum (RR: 1.03; 0.58, 1.81). There were similarly no differences in the components of the primary outcome at 36 weeks' [anxiety (RR: 0.85; 0.44, 1.62), vulnerability to depression (RR: 1.10; 0.43, 2.83), or poor mental health-related quality of life (RR: 1.05; 0.50, 2.20)] or at 6 months postpartum [anxiety (RR:1.21; 0.59, 2.48), vulnerability to depression (RR:1.41; 0.53, 3.79), poor mental health-related quality of life (RR: 1.11; 0.59, 2.08)]. CONCLUSION We found no evidence that adoption of tighter glycaemic treatment targets in women with gestational diabetes alters their mental health status at 36 weeks' gestation and at 6 months postpartum. TRIAL REGISTRATION The Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12615000282583 (ANZCTR-Registration). Date of registration: 25 March 2015.
Collapse
Affiliation(s)
| | - Thach Tran
- School of Biomedical Engineering, University of Technology Sydney, Sydney, Australia
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | |
Collapse
|
14
|
Yamamoto SS, Premji SS, Saini V, McDonald SW, Jhangri GS. Investigating associations between maternal stress, smoking and adverse birth outcomes: evidence from the All Our Families cohort. BMC Pregnancy Childbirth 2023; 23:710. [PMID: 37794335 PMCID: PMC10548639 DOI: 10.1186/s12884-023-06029-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 09/25/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Independently, active maternal and environmental tobacco smoke exposure and maternal stress have been linked to an increased risk of preterm birth and low birth weight. An understudied relationship is the potential for interactive effects between these risk factors. METHODS Data was obtained from the All Our Families cohort, a study of 3,388 pregnant women < 25 weeks gestation recruited from those receiving prenatal care in Calgary, Canada between May 2008 and December 2010. We investigated the joint effects of active maternal smoking, total smoke exposure (active maternal smoking plus environmental tobacco smoke) and prenatal stress (Perceived Stress Scale, Spielberger State-Trait Anxiety Inventory), measured at two time points (< 25 weeks and 34-36 weeks gestation), on preterm birth and low birth weight. RESULTS A marginally significant association was observed with the interaction active maternal smoking and Spielberger State-Trait Anxiety Inventory scores in relation to low birth weight, after imputation (aOR = 1.02, 95%CI: 1.00-1.03, p = 0.06). No significant joint effects of maternal stress and either active maternal smoking or total smoke exposure with preterm birth were observed. Active maternal smoking, total smoke exposure, Perceived Stress Scores, and Spielberger State-Trait Anxiety Inventory scores were independently associated with preterm birth and/or low birth weight. CONCLUSIONS Findings indicate the role of independent effects of smoking and stress in terms of preterm birth and low birthweight. However, the etiology of preterm birth and low birth weight is complex and multifactorial. Further investigations of potential interactive effects may be useful in helping to identify women experiencing vulnerability and inform the development of targeted interventions.
Collapse
Affiliation(s)
- Shelby S Yamamoto
- School of Public Health, University of Alberta, 11405 87th Ave, Edmonton, AB, T6G 1C9, Canada.
| | - Shahirose S Premji
- School of Nursing, Queen's University, 92 Barrie Street, Kingston, ON, K7L 3N6, Canada
| | - Vineet Saini
- Alberta Health Services, Department of Research and Innovation, Provincial Population and Public Health, 10030 - 107 Street NW, Edmonton, AB, T5J 3E4, Canada
- Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Sheila W McDonald
- Alberta Health Services, Department of Research and Innovation, Provincial Population and Public Health, 10030 - 107 Street NW, Edmonton, AB, T5J 3E4, Canada
- Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Gian S Jhangri
- School of Public Health, University of Alberta, 11405 87th Ave, Edmonton, AB, T6G 1C9, Canada
| |
Collapse
|
15
|
Foss S, Petty CR, Howell C, Mendonca J, Bosse A, Waber DP, Wright RJ, Enlow MB. Associations among maternal lifetime trauma, psychological symptoms in pregnancy, and infant stress reactivity and regulation. Dev Psychopathol 2023; 35:1714-1731. [PMID: 35678173 PMCID: PMC9732151 DOI: 10.1017/s0954579422000402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Maternal trauma has intergenerational implications, including worse birth outcomes, altered brain morphology, and poorer mental health. Research investigating intergenerational effects of maternal trauma on infant stress reactivity and regulation is limited. Maternal mental health during pregnancy may be a contributor: psychopathology is a sequela of trauma exposure and predictor of altered self-regulatory capacity in offspring of affected mothers. We assessed associations among maternal lifetime trauma and infant stress responsivity, mediated by psychological symptoms in pregnancy. Mothers reported lifetime trauma history and anxiety, depressive, and posttraumatic stress symptoms during pregnancy. At infant age 6 months, stress reactivity and regulation were assessed via maternal behavior ratings (Infant Behavior Questionnaire-Revised, IBQ-R) and behavioral (negative mood) and physiological (respiratory sinus arrhythmia, RSA) markers during a laboratory stressor (Still-Face Paradigm). Maternal trauma was directly associated with lower infant physiological regulation and indirectly associated with lower levels of both infant behavioral and physiological regulation via higher maternal anxiety during pregnancy. Maternal trauma was also indirectly associated with higher infant reactivity via higher maternal anxiety during pregnancy. Post hoc analyses indicated differential contributions of maternal prenatal versus postnatal anxiety to infant outcomes. Findings highlight potential contributory mechanisms toward maladaptive child stress response, which has been associated with poor behavioral, cognitive, and academic outcomes.
Collapse
Affiliation(s)
- Sophie Foss
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Carter R. Petty
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA, USA
| | - Caroline Howell
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
| | - Juliana Mendonca
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
| | - Abigail Bosse
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
| | - Deborah P. Waber
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Rosalind J. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Kravis Children’s Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michelle Bosquet Enlow
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
16
|
López-Morales H, Canet-Juric L, Del-Valle MV, Sosa JM, López MC, Urquijo S. Prenatal anxiety during the pandemic context is related to neurodevelopment of 6-month-old babies. Eur J Pediatr 2023; 182:4213-4226. [PMID: 37452845 DOI: 10.1007/s00431-023-05112-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/27/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
Prenatal anxiety and depression in pandemic context could introduce changes in the fetal developmental trajectories that, ultimately, could alter the adaptive behaviors of the offspring, potentially affecting, for example, general neurodevelopment. The sample consisted of 105 mother-child dyads, recruited between March and May 2020. The dyads were evaluated longitudinally, prenatally and postnatally (6 months). The Pandemic Impact Questionnaire, the State-Trait Anxiety Inventory, and the Beck-II Depression Inventory were used to assess indicators of maternal anxiety and depression, respectively. Regarding the babies, their mothers responded to Age and Stages: 3, which assesses different dimensions of early neurodevelopment, in addition to a closed questionnaire to identify sociodemographic and maternal and child health variables. A series of mediation models were tested to examine the association between prenatal psychopathology/negative experiences of the pandemic and neurodevelopment. The results indicated that the negative experiences of the pandemic were indirectly associated with the socio-individual and fine motor neurodevelopment of the offspring, through maternal anxiety symptoms, during the third trimester, which functioned as a mediator. Conclusions: This study provides evidence on the mediating effects of maternal anxiety on infant neurodevelopment in contexts of early adversity. It is important to point out the need to implement public health policies that allow a timely evaluation of neurodevelopmental variables during early childhood, which can implement early interventions to reduce the risks associated with these deficits. What is Known: • Effects of maternal mental health have been reported, effects on child neurodevelopment, in motor, cognitive, linguistic and socio-emotional dimensions. • Contexts of early adversity have been associated with maternal mental health and offspring development. What is New: • The context of pandemic adversity caused by COVID-19 is associated with motor and socio-individual neurodevelopment, mediated by maternal prenatal anxiety.
Collapse
Affiliation(s)
- Hernán López-Morales
- Instituto de Psicología Básica Aplicada y Tecnología (IPSIBAT), Mar del Plata, Argentina.
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina.
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
- Escuela Superior de Medicina, Universidad Nacional de Mar del Plata, Mar del Plata, Argentina.
| | - Lorena Canet-Juric
- Instituto de Psicología Básica Aplicada y Tecnología (IPSIBAT), Mar del Plata, Argentina
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Macarena Verónica Del-Valle
- Instituto de Psicología Básica Aplicada y Tecnología (IPSIBAT), Mar del Plata, Argentina
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Julieta Mariel Sosa
- Instituto de Psicología Básica Aplicada y Tecnología (IPSIBAT), Mar del Plata, Argentina
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina
| | - Marcela Carolina López
- Instituto de Psicología Básica Aplicada y Tecnología (IPSIBAT), Mar del Plata, Argentina
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina
| | - Sebastián Urquijo
- Instituto de Psicología Básica Aplicada y Tecnología (IPSIBAT), Mar del Plata, Argentina
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| |
Collapse
|
17
|
Subbiah GK, Reijneveld SA, Hartman CA, van der Zee-van den Berg AI, Boere-Boonekamp MM, Almansa J, de Kroon MLA. Impact of trajectories of maternal postpartum depression on infants' socioemotional development. Pediatr Res 2023:10.1038/s41390-023-02697-w. [PMID: 37337109 DOI: 10.1038/s41390-023-02697-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/27/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND We assessed (a) the effects of postpartum depression (PPD) trajectories until 6 months postpartum on infants' socioemotional development (SED) at age 12 months, and (b) the mediating role of maternal self-efficacy (MSE), and the additional effect of postpartum anxiety at age 12 months. METHODS We used data from POST-UP trial (n = 1843). PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS) at 1, 3, and 6 months. Infants' SED was assessed at 12 months using the Ages and Stages Questionnaire-Social-Emotional (ASQ-SE). Structural equations were applied to estimate the effect of PPD trajectories on infants' SED and mediation by MSE. The additional effects of postpartum anxiety were assessed with conditional regression. RESULTS Higher levels of PPD over time were associated with a lower SED (coefficient for log-EPDS 3.5, 95% confidence interval 2.8; 4.2, e.g., an increase in the EPDS score from 9 to 13 worsens the ASQ-SE by 1.3 points). About half of this relationship was mediated by MSE. Postpartum anxiety had an independent adverse effect on SED. CONCLUSIONS PPD and postpartum anxiety have a negative impact on infants' SED. MSE as a mediator may be a potential target for preventive interventions to alleviate the negative effects of maternal psychopathology on infants' SED. IMPACT The trajectories of postpartum depression (PPD) from 1 month to 6 months were negatively related to infants' socioemotional development (SED) at age 12 months, underlining the importance of repeated assessment of PPD. Maternal self-efficacy (MSE) mediated the association between PPD and SED, implying MSE could be a potential target for preventive interventions. An additional independent negative effect of postpartum anxiety was identified, implying the assessment of postpartum anxiety also has a surplus value to identify mothers at risk.
Collapse
Affiliation(s)
- Gireesh Kumar Subbiah
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, the Netherlands.
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, the Netherlands
| | - Catharina A Hartman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | | | - Magda M Boere-Boonekamp
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
| | - Josué Almansa
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, the Netherlands
| | - Marlou L A de Kroon
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, the Netherlands
- Department of Public Health and Primary Care, Environment and Health, KU Leuven, Kapucijnenvoer 35, P.O. Box 7001, 3000, Leuven, Belgium
| |
Collapse
|
18
|
López-Morales H, Del-Valle MV, López MC, Andrés ML, García MJ, Canet-Juric L, Urquijo S. Maternal anxiety, exposure to the COVID-19 pandemic and socioemotional development of offspring. JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 2023; 86:101517. [PMID: 36748034 PMCID: PMC9892320 DOI: 10.1016/j.appdev.2023.101517] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 01/20/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
The COVID-19 pandemic context may predispose mothers to increased maternal psychopathology, which may be associated with offspring socioemotional development. The aim of this study is to analyze the relationships between prenatal anxiety and depression and exposure to the COVID-19 pandemic with offspring socioemotional development, controlling for postnatal anxiety and depression. A total of 105 mother-child dyads were assessed in pre- and postnatal periods. Questionnaires were used to assess the impact of the pandemic, indicators of psychopathology, and the socioemotional development of the offspring. Results suggest that negative pandemic experiences are indirectly associated with offspring socioemotional development via prenatal maternal anxiety symptomatology and after controlling for postnatal anxiety and depression. These indicators predispose to emotional deficits and increase the risks of psychopathological and neurodevelopmental disorders. It is important to adopt health policies that provide timely assessment of development in early childhood to reduce the risks associated with these deficits.
Collapse
Affiliation(s)
- Hernán López-Morales
- Instituto de Psicología Básica Aplicada y Tecnología (IPSIBAT), Mar del Plata, Argentina
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
- Escuela Superior de Medicina, Universidad Nacional de Mar del Plata, Argentina
| | - Macarena Verónica Del-Valle
- Instituto de Psicología Básica Aplicada y Tecnología (IPSIBAT), Mar del Plata, Argentina
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Marcela Carolina López
- Instituto de Psicología Básica Aplicada y Tecnología (IPSIBAT), Mar del Plata, Argentina
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - María Laura Andrés
- Instituto de Psicología Básica Aplicada y Tecnología (IPSIBAT), Mar del Plata, Argentina
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Matías Jonás García
- Instituto de Psicología Básica Aplicada y Tecnología (IPSIBAT), Mar del Plata, Argentina
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Lorena Canet-Juric
- Instituto de Psicología Básica Aplicada y Tecnología (IPSIBAT), Mar del Plata, Argentina
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Sebastián Urquijo
- Instituto de Psicología Básica Aplicada y Tecnología (IPSIBAT), Mar del Plata, Argentina
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| |
Collapse
|
19
|
Bryant AS, Coleman J, Shi X, Rodriguez M, Papadopoulos AS, Merz K, Leonard J, Samia N, Marceau L. The Power and Promise of Postpartum Self Care: Evaluation of a Web-Based Tool for Underserved Women. Matern Child Health J 2023; 27:548-555. [PMID: 36732464 PMCID: PMC9894665 DOI: 10.1007/s10995-023-03605-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Joyuus is a culturally diverse, comprehensive online tool designed to address the self-care needs of underserved postpartum women. The tool provides actionable self-care information, knowledge, and skills to improve postpartum health and identifies red flags for when self-care shifts to seeking care. METHODS We employed a mixed-methods multiphase design to evaluate the Joyuus prototype, including a pre-post evaluation (N = 87) to assess behavioral health outcomes before and after using the tool for a one-month period. 91% completed the post-test (N = 79). The analysis focused on estimation of treatment effect (via 95% confidence intervals) and fitness of instruments in this population. RESULTS Participants were between 6 months pregnant and one year postpartum, a mean age of 30 years, 100% female, 99% Black, with nearly equal distribution of married (55%) and not married (44%), and above (47%) and below (46%) annual income of $60 K. Key measures saw significant improvement from pre- (mean = 26.44, SD = 5.39) to post (mean = 28.29, SD = 5.26) on the Connor-Davidson Resilience Scale (p < 0.001) Trends toward improvement (not statistically significant) were noted for Depression (EPDS) (p = 0.624) and Anxiety (STAI) (p = 0.286), and no meaningful change on MOS Social Support or COVID-19 Mental Health Impacts Measures. CONCLUSIONS FOR PRACTICE This pilot study demonstrates that a self-care mobile tool has the potential to address significant health outcomes related to maternal morbidity and mortality. By providing a continuously available companion addressing physical, mental, and real-life questions, it creates value during postpartum for mothers who can often feel overwhelmed or isolated.
Collapse
Affiliation(s)
- Allison S Bryant
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Julia Coleman
- HealthCore, Inc., 55 Chapel Street, Newton, MA, 02458, USA
| | - Xiaomei Shi
- Collective Insight, 4 Pickard Ln, North Reading, MA, 01864-2451, USA.,LeadingAge LTSS Center at the University of Massachusetts, 100 Morrissey Blvd., Boston, MA, 02125, USA
| | | | | | - Kristine Merz
- Joyuus, LLC, 15 Victory Highway, West Greenwich, RI, 02817, USA.,Orange Square, 15 Victory Highway, West Greenwich, RI, 02817, USA
| | - Juli Leonard
- Orange Square, 15 Victory Highway, West Greenwich, RI, 02817, USA
| | - Neela Samia
- Orange Square, 15 Victory Highway, West Greenwich, RI, 02817, USA
| | - Lisa Marceau
- Joyuus, LLC, 15 Victory Highway, West Greenwich, RI, 02817, USA. .,Alpha Millennial Health, Cumberland, RI, USA.
| |
Collapse
|
20
|
Rau NM, Mcintosh JJ, Flynn KE, Szabo A, Ahamed SI, Asan O, Hasan MK, Basir MA. Multimedia tablet or paper handout to supplement counseling during preterm birth hospitalization. Am J Obstet Gynecol MFM 2023; 5:100875. [PMID: 36708966 DOI: 10.1016/j.ajogmf.2023.100875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND Parents of premature infants engage in shared decision-making regarding the care of their infant. The process of prenatal counseling typically involves a verbal conversation with a neonatal provider during hospitalization. Support people may not be available, and the pregnant person's memory is impaired by medications, pain, and stress. The American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development have called for improvements to this process, including the development of educational aids. OBJECTIVE This study aimed to investigate whether a multimedia tablet would be more effective than a paper handout in supplementing verbal clinician counseling during preterm birth hospitalization. STUDY DESIGN This was a randomized controlled trial including English-speaking pregnant people aged ≥18 years and hospitalized at 22 to 33 weeks' gestation for preterm birth. Exclusion criteria were known fetal or chromosomal anomaly and delivery before study completion. Pregnant people received either a multimedia tablet or a paper handout before verbal clinician counseling. Preintervention assessment included demographics and State-Trait Anxiety Inventory, and postintervention assessment included the Parent Knowledge of Premature Birth Questionnaire and State-Trait Anxiety Inventory. Continuous variables were analyzed by t-test and categorical variables by Fisher exact test. RESULTS A total of 122 pregnant people referred for counseling were screened; 76 were randomized, and 59 completed the study. Demographics were similar between groups, except that pregnant people in the handout group were older (mean 32 vs 29 years; P=.03). The multimedia tablet group (n=32) was less likely to report reviewing all the educational material than the paper handout group (n=27) (41% vs 72%; P=.037). Both groups correctly answered a similar number of knowledge items (P=.088). Postintervention state anxiety decreased in both groups (P<.0001), with no difference between groups. Computerized tracking showed that the multimedia group spent a median of 37 minutes reviewing the tablet. CONCLUSION Contrary to our hypothesis, a paper handout and multimedia tablet were equally effective in the labor unit for supplementing verbal preterm birth counseling, and both decreased parental anxiety.
Collapse
Affiliation(s)
- Nicole M Rau
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI (Drs Rau and Basir)
| | - Jennifer J Mcintosh
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI (Dr Mcintosh)
| | - Kathryn E Flynn
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI (Drs Flynn and Asan)
| | - Aniko Szabo
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Dr Szabo)
| | - Sheikh Iqbal Ahamed
- Department of Computer Science, Marquette University, Milwaukee, WI (Drs Ahamed and Hasan)
| | - Onur Asan
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI (Drs Flynn and Asan)
| | - Md Kamrul Hasan
- Department of Computer Science, Marquette University, Milwaukee, WI (Drs Ahamed and Hasan)
| | - Mir A Basir
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI (Drs Rau and Basir).
| |
Collapse
|
21
|
Murnan AW, Keim SA, Li R, Klebanoff MA. Marijuana use and sleep quality during pregnancy. J Matern Fetal Neonatal Med 2022; 35:7857-7864. [PMID: 34102934 PMCID: PMC9513436 DOI: 10.1080/14767058.2021.1937987] [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: 10/21/2022]
Abstract
OBJECTIVE Marijuana use among pregnant women is on the rise in part due to the perception that marijuana may improve problems related to pregnancy such as poor sleep. This study's objective was to examine associations between marijuana use and sleep quality among a sample of women during pregnancy. MATERIAL AND METHODS The sample included women seeking prenatal care at The Ohio State University Wexner Medical Center (2010-2015). Intake assessments included medical, demographic, and socioeconomic domains, as well as the Pittsburgh Sleep Quality Index. Marijuana use during pregnancy was determined using urine screens, chart abstraction, and self-report. Women completed standardized questionnaires regarding sleep quality, depressive symptoms, anxiety, stress, and discrimination at enrollment and each subsequent trimester. A linear mixed-effect model was used to assess the relationship between sleep variables and marijuana use adjusted for maternal race, education, household income, age, marital status, depressive symptoms, anxiety, stress, discrimination, and use of tobacco and other substances during pregnancy. Women completed the sleep quality assessments for a total of 294 pregnancies, which comprise the study population. RESULTS Among the study sample (n = 294), 93 women used marijuana and 201 women did not use marijuana during their pregnancies. Women who used marijuana (n = 93) were more likely to identify as African-American (73% vs 58%; p = .01), report government health insurance (98% vs 89%; p = .001), use tobacco during pregnancy (66% vs 33%; p < .001), report less household income (70% vs 43% < 10,000 annual household income; p < .001), and be unmarried (69% vs 49%; p < .001) compared to women who did not. Mean sleep quality was similar among women who did (µ = 7.6; SD = 4.0) and did not use marijuana during pregnancy (µ = 7.7; SD = 4.0), and both groups had a mean score worse than the conventional cutoff for poor sleep quality (>5). In fact, both groups reported worse sleep than is typically observed among cohorts reporting poor sleep, which have ranged from 5.3 to 6.3. CONCLUSIONS Current findings did not suggest differences in sleep quality between women who used and did not use marijuana during pregnancy. Findings are contrary to the perception that marijuana use alleviates sleep-related problems during pregnancy. Given well-documented adverse outcomes associated with prenatal marijuana exposure for children and the increase in women using marijuana during pregnancy, providers should be prepared to discuss possible harms associated with marijuana use during pregnancy as well as provide psychoeducational information and service referrals to those interested. Future studies could improve upon this design by assessing objective measures of sleep, such as actigraphy, as well as marijuana use repeatedly throughout pregnancy, which may be a more optimal strategy for illuminating potential relationships between marijuana use and sleep during pregnancy.
Collapse
Affiliation(s)
- Aaron W. Murnan
- Center for Bio-behavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Sarah A. Keim
- Center for Bio-behavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA;,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA;,Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Rui Li
- Center for Bio-behavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA;,Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Ohio, USA
| | - Mark A. Klebanoff
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA;,Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA;,Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Ohio, USA;,Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
| |
Collapse
|
22
|
Mappa I, Luviso M, Distefano FA, Carbone L, Maruotti GM, Rizzo G. Women perception of SARS-CoV-2 vaccination during pregnancy and subsequent maternal anxiety: a prospective observational study. J Matern Fetal Neonatal Med 2022; 35:6302-6305. [PMID: 33843419 DOI: 10.1080/14767058.2021.1910672] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The use of Coronavirus 2 (SARS-CoV-2) vaccine in pregnant women is controversial and still not performed in Italy. Our objective was to evaluate the propensity of a population of Italian women to receive the vaccine and its psychological impact. METHODS A prospective, observational study was performed on pregnant women attending Ospedale Cristo Re Università Roma TorVergata. A multi-section questionnaire was sent to each included woman on the first day of available SARS-CoV-2 vaccination. Part-A was finalized to acquire maternal characteristics and to test the women's perception of vaccinations in pregnancy and their fear-induced by vaccines. Part-B included the State-Trait-Anxiety-Inventory (STAI) a validated test for scoring trait anxiety (basal anxiety, STAI-T) and state anxiety (STAI-S). An abnormal value of STAI was considered when ≥40. Comparisons of maternal variables were performed according to their vaccine attitude. RESULTS The questionnaire was completed by 161 women (80.5% of the population considered). A positive attitude toward the vaccine was present in 136 (84.5%) women (positive) while the remaining 25.5% considered the vaccine not useful (negative). Among the former group 52.9% were favorable to obtain the vaccine during pregnancy despite the current national limitations, a percentage significantly higher (p = .02) than in the negative groups. Women with a negative attitude to the vaccine had a lower educational (p = .002) and employment level (p = .016) when compared to the positive group. In all the women a significant increase of STAI-S from STAI-T values was evidenced (p < .0001). The incidence of abnormal STAI T values (basal anxiety) was similar between the 2 groups (p = .81), while there was a significant increase of STAI-S values in the negative group (negative 88.0%; vs positive 63.4%; p = .018). CONCLUSIONS The majority of pregnant women considered have a positive attitude to SARS-CoV-2 vaccine. Vaccine campaign seems to increase the maternal level of anxiety and this increase is more marked with a negative attitude toward the vaccine.
Collapse
Affiliation(s)
- Ilenia Mappa
- Division of Maternal Fetal Medicine, Ospedale Cristo Re Roma, Università di Roma Tor Vergata, Roma, Italy
| | - Maria Luviso
- Division of Maternal Fetal Medicine, Ospedale Cristo Re Roma, Università di Roma Tor Vergata, Roma, Italy
| | - Flavia Adalgisa Distefano
- Division of Maternal Fetal Medicine, Ospedale Cristo Re Roma, Università di Roma Tor Vergata, Roma, Italy
| | - Luigi Carbone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University of Naples, Naples, Italy
| | - Giuseppe Maria Maruotti
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University of Naples, Naples, Italy
| | - Giuseppe Rizzo
- Division of Maternal Fetal Medicine, Ospedale Cristo Re Roma, Università di Roma Tor Vergata, Roma, Italy
- Department of Obstetrics and Gynecology Moscow, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| |
Collapse
|
23
|
Shahbazzadegan S, Nikjou R. The most appropriate cervical dilatation for massage to reduce labor pain and anxiety: a randomized clinical trial. BMC Womens Health 2022; 22:282. [PMID: 35799221 PMCID: PMC9264534 DOI: 10.1186/s12905-022-01864-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Managing labor pain by performing massage is one of the useful strategies to reduce the rate of cesarean section and increase the tendency of women for pregnancy. Therefore, it is necessary to determine the best time for massage therapy to reduce the labor pain and anxiety. In this regard, the present study was conducted to determine the cervical dilatation appropriate for performing massage in order to reduce the labor pain and anxiety.
Methods
This randomized clinical trial study was conducted on 60 nulliparous pregnant women. Eligible participants with active phase of labor were divided randomly into two groups. The intervention group received the massage three times in of dilatation 5–7–9 cm for 20 min each time by same person without the use of oil in the LDR, based on Kimber massage instructions. In the control group, all routine care was performed except massage. Pain intensity was assessed using pain ruler. Demographic and anxiety data were collected through questionnaires.
Results
The difference between the mean pains in the studied groups was significant in 7 cm (p < 0.0001) of cervical dilatation but was not significant in 5 cm (p = 0.084) and 9 cm (p = 0.591) dilatation. Massage effectively decreased pain intensity. The mean maternal anxiety was not significant at the beginning of the study, but was significant after performing massage (p < 0.0001) and anxiety score in the massage group decreased from 63.36 ± 5.28 (severe anxiety) at the beginning to 42.60 ± 5.83 (moderate anxiety) at the end of the study. In the control group, it increased from 66.33 ± 7.66 to 67.1 ± 5.65.
Conclusion
The appropriate dilatation of cervix for massage in order to reduce labor pain was observed in 7 cm. Also, massage had a significant effect on reducing anxiety. Therefore, massage is recommended as a routine care in 7 cm cervical dilatations.
Trial registration
This trial was registered with the Iran Trial Center (trial ID: IRCT20140118016255N5). https://en.irct.ir/trial/28120
Collapse
|
24
|
López-Morales H, Gelpi Trudo R, del-Valle MV, Canet-Juric L, Biota M, Andrés ML, Urquijo S. The Pandemial babies: effects of maternal stress on temperament of babies gestated and born during the pandemic. CURRENT PSYCHOLOGY 2022:1-13. [PMID: 36437907 PMCID: PMC9676865 DOI: 10.1007/s12144-022-03976-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 11/21/2022]
Abstract
The COVID-19 pandemic may configure an adverse prenatal context for early development. The aim of this study was to analyze the effects of pandemic-related negative experiences, prenatal anxiety and depression on the temperament of six-month-old babies. The sample consisted of 105 mother-child dyads. A longitudinal evaluation was carried out using pre- and postnatal online surveys. Mothers completed the State-Trait Anxiety Inventory, the Beck Depression Inventory - II, the Pandemic Impact Questionnaire and the Infant Behavior Questionnaire Revised. Serial mediation models were tested, in which the pandemic-related negative experiences constituted the independent variable, the prenatal anxiety and depression were the mediators, and the children's temperament dimensions were the dependent variables. Pandemic-related negative experiences were indirectly associated with the offspring's negative affect and surgency through anxious symptomatology, which acted as a mediating variable. This was the first study to identify the effects of the COVID-19 pandemic on temperament. Such an adverse context implies risks for child development. Public health policies aiming to evaluate socioemotional variables during early childhood become necessary to allow on-time interventions for lessening these risks.
Collapse
Affiliation(s)
- Hernán López-Morales
- Instituto de Psicología Básica Aplicada Y Tecnología (IPSIBAT), Mar del Plata, Argentina
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Escuela Superior de Medicina, Universidad Nacional de Mar del Plata, Mar del Plata, Argentina
| | - Rosario Gelpi Trudo
- Instituto de Psicología Básica Aplicada Y Tecnología (IPSIBAT), Mar del Plata, Argentina
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Macarena Verónica del-Valle
- Instituto de Psicología Básica Aplicada Y Tecnología (IPSIBAT), Mar del Plata, Argentina
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Lorena Canet-Juric
- Instituto de Psicología Básica Aplicada Y Tecnología (IPSIBAT), Mar del Plata, Argentina
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Magdalena Biota
- Unidad Ejecutora de Estudios en Neurociencias Y Sistemas Complejos (CONICET - Hospital El Cruce - Universidad Nacional Arturo Jauretche), Buenos Aires, Argentina
| | - María Laura Andrés
- Instituto de Psicología Básica Aplicada Y Tecnología (IPSIBAT), Mar del Plata, Argentina
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Sebastián Urquijo
- Instituto de Psicología Básica Aplicada Y Tecnología (IPSIBAT), Mar del Plata, Argentina
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| |
Collapse
|
25
|
Daire C, de Tejada BM, Guittier MJ. Fathers' anxiety levels during early postpartum: A comparison study between first-time and multi-child fathers. J Affect Disord 2022; 312:303-309. [PMID: 35760186 DOI: 10.1016/j.jad.2022.06.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/01/2022] [Accepted: 06/20/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The postnatal period is considered the most challenging period in the adjustment to fatherhood. This study aimed to assess anxiety levels among fathers during this period. METHODS A comparative study assessing the anxiety levels of first-time and multi-child fathers before the mother and child returned home (0-7 days after birth) was conducted. We used the French validation of the State-Trait Anxiety Inventory (STAI). RESULTS Among 235 fathers who were met at the maternity ward, 182 (77 %) responded to the questionnaire. For most fathers in both groups, anxiety levels were low or very low for trait anxiety (166/182, 91.21 %) and state anxiety (177/182, 97.25 %). Levels of state anxiety were statistically higher for first-time fathers compared to multi-child fathers but were mainly at a low or very low level (70/83 [84 %] versus 71/99 [71 %], respectively, p = 0.029). The multiple linear regression showed that "feeling prepared at birth time" was the only significantly (p < 0.001) associated factor with state anxiety among first-time fathers only. LIMITATIONS The validity and reliability of the STAI have been widely proven for the general population but not specifically for men during the postpartum period. CONCLUSIONS Most fathers had low to very low anxiety levels during the early postpartum period, suggesting that developing new specific support interventions is not needed during early postnatal care. Further research focusing on when the family is back home is warranted.
Collapse
Affiliation(s)
- C Daire
- University of Applied Sciences and Arts Western Switzerland (HES-SO) and University of Lausanne (UNIL), Switzerland
| | - B Martinez de Tejada
- Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - M J Guittier
- Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland; School of Health Sciences Geneva HES-SO, University of Applied Sciences and Arts Western, Switzerland.
| |
Collapse
|
26
|
Diotaiuti P, Valente G, Mancone S, Falese L, Corrado S, Siqueira TC, Andrade A. A Psychoeducational Intervention in Prenatal Classes: Positive Effects on Anxiety, Self-Efficacy, and Temporal Focus in Birth Attendants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137904. [PMID: 35805564 PMCID: PMC9266264 DOI: 10.3390/ijerph19137904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/18/2022] [Accepted: 06/24/2022] [Indexed: 01/27/2023]
Abstract
Background: Previous studies have reported associations between high maternal anxiety, temporal perceptions during pregnancy, and a poor sense of self-efficacy. One type of anxiety expecting mothers experience is associated with childbirth, which previous studies have shown can be reduced by antenatal training. Recent contributions have pointed out that current prenatal courses, while providing important and useful knowledge, do not devote sufficient content to the mental health of the parturient and to the psychological issues that can arise before and after the birth. Methods: In total, 80 pregnant women were provided with a special prepartum course in which ample space was devoted to topics such as maternal mental health, parenting skills and couple relationship, relaxation techniques, and assertiveness. Perception of threat, state anxiety, temporal focus, needs and expectations, and self-efficacy were assessed by comparing this psychoeducational intervention group with a traditional antenatal course group (n = 80), and a control group (n = 80). Two-way mixed ANOVAS (3 × 2) were performed for each dependent variable considered, including the time variable (pre-course–post-course) as a factor within the participants and the group variable as a factor between the subjects. Results: The psychoeducational intervention actually induced significant and positive changes primarily on four dimensions: state anxiety, perceived self-efficacy, the need for information, and reassurance of the pregnant women who participated in this trial. Conclusions: The study suggests improving the quality of prenatal classes by paying particular attention to the content and communication used within the group, in order to gratify at the highest level, the need for information, reassurance, and sharing that characterize the parturient’s request for support. The evidence collected recommends further replicating the intervention protocol described in order to improve the psychophysical well-being of women in a delicate moment such as pregnancy and preparation for childbirth, but especially in terms of the prevention and containment of the risks of psychological distress that currently affect a significant number of women after childbirth.
Collapse
Affiliation(s)
- Pierluigi Diotaiuti
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy; (G.V.); (S.M.); (L.F.); (S.C.)
- Correspondence:
| | - Giuseppe Valente
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy; (G.V.); (S.M.); (L.F.); (S.C.)
| | - Stefania Mancone
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy; (G.V.); (S.M.); (L.F.); (S.C.)
| | - Lavinia Falese
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy; (G.V.); (S.M.); (L.F.); (S.C.)
| | - Stefano Corrado
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy; (G.V.); (S.M.); (L.F.); (S.C.)
| | - Thais Cristina Siqueira
- Health and Sports Science Center, Department of Physical Education, CEFID, Santa Catarina State University, Florianópolis 88035-901, Brazil; (T.C.S.); (A.A.)
| | - Alexandro Andrade
- Health and Sports Science Center, Department of Physical Education, CEFID, Santa Catarina State University, Florianópolis 88035-901, Brazil; (T.C.S.); (A.A.)
| |
Collapse
|
27
|
Mirzaee F, Hasanpoor-Azghady SB, Amiri-Farahani L. Correlation between religious coping, demographic and fertility factors, and pregnancy anxiety of Iranian primiparous women: a cross-sectional study. BMC Psychiatry 2022; 22:298. [PMID: 35484516 PMCID: PMC9047326 DOI: 10.1186/s12888-022-03922-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 04/08/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Anxiety during pregnancy can have side effects for both the mother and the baby. Therefore, it is necessary to study the factors that affect anxiety during pregnancy. This study aimed to investigate the role of religious coping and demographic and fertility factors in predicting pregnancy anxiety in Iranian primiparous women. METHODS We conducted a cross-sectional study on 300 primiparous women (n = 100 in each trimester of pregnancy) referred to seven health centers affiliated to the Iran University of Medical Sciences, Tehran, Iran. The sampling method was multistage. It lasted from July 2018 till August 2019. Data collection tools included the demographic and fertility questionnaire, valid and reliable Iranian Religious Coping Scale (IRCS), and standard State-Trait Anxiety Inventory (STAI). RESULTS Religious practices, benevolent reappraisal, and active religious coping had a significant inverse relationship with state and trait anxiety. Whereas negative and passive religious coping had a significant direct relationship with state and trait anxiety. The mean scores of state anxiety had a significant relationship with the women's education, spouse's education and occupation, economic status and housing status. There was no relationship between state anxiety and fertility variables. Based on multiple linear regression, negative and active religious coping predicted 27% of state anxiety and 15% of trait anxiety. Among these two variables, the negative religious coping was the more effective in predicting state and trait anxiety. CONCLUSION With increasing positive religious coping, the anxiety of pregnant women decreased. Whereas with increasing negative religious coping, their anxiety increased. Our results emphasize the role of negative religious coping in predicting pregnancy anxiety.
Collapse
Affiliation(s)
- Foruzan Mirzaee
- grid.411746.10000 0004 4911 7066Department of Midwifery and Reproductive, Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Batool Hasanpoor-Azghady
- Department of Midwifery and Reproductive, Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
| | - Leila Amiri-Farahani
- grid.411746.10000 0004 4911 7066Department of Midwifery and Reproductive, Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
28
|
Doty MS, Chen HY, Grace R, Ashimi SS, Chauhan SP. Stress, anxiety and depression levels in pregnancy: outpatient versus inpatient. J Matern Fetal Neonatal Med 2022; 35:9608-9613. [PMID: 35477337 DOI: 10.1080/14767058.2022.2049748] [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: 10/18/2022]
Abstract
OBJECTIVE To compare stress, anxiety and depression levels among 3 groups of pregnant women: 1) low-risk outpatient (LRO), 2) high-risk outpatient (HRO), and 3) inpatient (IP). METHODS This was a cross-sectional study using validated instruments. Inclusion criteria were pregnancies 23-37 weeks and maternal age > 18 years. The primary outcome was mean/median scores of Perceived Stress Scale (PSS), State Trait Anxiety Inventory (STAI), and Edinburgh Depression Scale (EDS). Secondary outcome was rate of abnormal scores. RESULTS Among 190 women approached, 180 (95%) participated, with 60 (33%) in each group. Mean PSS scores (range 0-40) significantly increased from LRO (12.0, standard deviation [SD] 7.8) to HRO (14.7, SD 7.9) to IP (15.6, SD 8.2); p = .04. Mean STAI scores (range 20-80) also significantly increased from LRO (32.0, SD 11.1) to HRO (35.8, SD 11.9) to IP (40.9, SD 13.1); p < .01. Abnormal anxiety (STAI ≥ 40) was present in 40% of women and significantly higher among IP compared to LRO (56% vs 25%; RR 2.24, 95% CI 1.36-3.67; aRR 2.24, 95% CI 1.34-3.74). CONCLUSION Stress and anxiety scores significantly differ in LRO, HRO, and IP women. While depression screening is common postpartum, screening for stress, anxiety and depression prenatally may be beneficial.
Collapse
Affiliation(s)
- Morgen S Doty
- Mednax, Obstetrix Maternal-Fetal Medicine Specialists of Houston, Houston, TX, USA
| | - Han-Yang Chen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rebecca Grace
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Sunbola S Ashimi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| |
Collapse
|
29
|
Levin-Schwartz Y, Cowell W, Leon Hsu HH, Enlow MB, Amarasiriwardena C, Andra SS, Wright RJ, Wright RO. Metal mixtures are associated with increased anxiety during pregnancy. ENVIRONMENTAL RESEARCH 2022; 204:112276. [PMID: 34717944 PMCID: PMC8671328 DOI: 10.1016/j.envres.2021.112276] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/29/2021] [Accepted: 10/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Exposure to low-dose toxic metals in the environment is ubiquitous. Several murine studies have shown metals induce anxiety-like behaviors, and mechanistic research supports that metals disrupt neurotransmitter signaling systems implicated in the pathophysiology of anxiety. In this study, we extend prior research by examining joint exposure to six metals in relation to maternal anxiety symptoms during pregnancy. METHODS The sample includes 380 participants enrolled in the PRogramming of Intergenerational Stress Mechanisms (PRISM) pregnancy cohort. Spot urine was collected during pregnancy (mean ± standard deviation: 31.1 ± 6.1 weeks), and concentrations of six metals (barium [Ba], cadmium [Cd], chromium [Cr], cesium [Cs], lead [Pb], antimony [Sb]) were measured by Inductively Coupled Plasma - Mass Spectrometry. Trait anxiety symptoms were measured during pregnancy using a short version of the Spielberger State Trait Anxiety Inventory (STAI-T) and information on covariates was collected by questionnaire. We used weighted quantile sum (WQS) regression as the primary modeling approach to examine metals, treated as a mixture, in relation to higher (≥20) vs. lower anxiety symptoms while adjusting for urinary creatinine and key sociodemographic variables. RESULTS The sample is socioeconomically and racially/ethnically diverse. Urinary metal concentrations were log-normally distributed and 25% of the sample had an STAI-T score ≥20. Joint exposure to metals was associated with elevated anxiety symptoms (ORWQS = 1.56, 95% CI: 1.24, 1.96); Cd (61.8%), Cr (14.7%), and Cs (12.7%) contributed the greatest weight to the mixture effect. CONCLUSION Exposure to metals in the environment may be associated with anxiety symptoms during pregnancy. This is a public health concern, as anxiety disorders are highly prevalent and associated with significant co-morbidities, especially during pregnancy when both the mother and developing fetus are susceptible to adverse health outcomes.
Collapse
Affiliation(s)
- Yuri Levin-Schwartz
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Whitney Cowell
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Hsiao-Hsien Leon Hsu
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michelle Bosquet Enlow
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Chitra Amarasiriwardena
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Syam S Andra
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rosalind J Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert O Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
30
|
Dawes L, Waugh JJS, Lee A, Groom KM. Psychological well-being of women at high risk of spontaneous preterm birth cared for in a specialised preterm birth clinic: a prospective longitudinal cohort study. BMJ Open 2022; 12:e056999. [PMID: 35232790 PMCID: PMC8889323 DOI: 10.1136/bmjopen-2021-056999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the psychological well-being of pregnant women at increased risk of spontaneous preterm birth, and the impact of care from a preterm birth clinic. DESIGN Single-centre longitudinal cohort study over 1 year, 2018-2019. SETTING Tertiary maternity hospital in Auckland, New Zealand. PARTICIPANTS Pregnant women at increased risk of spontaneous preterm birth receiving care in a preterm birth clinic. INTERVENTION Participants completed three sets of questionnaires (State-Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale, and 36-Item Short Form Survey)-prior to their first, after their second, and after their last clinic appointments. Study-specific questionnaires explored pregnancy-related anxiety and perceptions of care. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the mean State-Anxiety score. Secondary outcomes included depression and quality of life measures. RESULTS 73/97 (75.3%) eligible women participated; 41.1% had a previous preterm birth, 31.5% a second trimester loss and 28.8% cervical surgery; 20.6% had a prior mental health condition. 63/73 (86.3%) women completed all questionnaires. The adjusted mean state-anxiety score was 39.0 at baseline, which decreased to 36.5 after the second visit (difference -2.5, 95% CI -5.5 to 0.5, p=0.1) and to 32.6 after the last visit (difference -3.9 from second visit, 95% CI -6.4 to -1.5, p=0.002). Rates of anxiety (state-anxiety score >40) and depression (Edinburgh Postnatal Depression Scale score >12) were 38.4%, 34.8%, 19.0% and 13.7%, 8.7%, 9.5% respectively, at the same time periods. Perceptions of care were favourable; 88.9% stated the preterm birth clinic made them significantly or somewhat less anxious and 87.3% wanted to be seen again in a future pregnancy. CONCLUSIONS Women at increased risk of spontaneous preterm birth have high levels of anxiety. Psychological well-being improved during the second trimester; women perceived that preterm birth clinic care reduced pregnancy-related anxiety. These findings support the ongoing use and development of preterm birth clinics.
Collapse
Affiliation(s)
- Lisa Dawes
- Liggins Institute, The University of Auckland, Auckland, New Zealand
- National Women's Health, Auckland City Hospital, Auckland, New Zealand
| | - Jason J S Waugh
- National Women's Health, Auckland City Hospital, Auckland, New Zealand
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| | - Arier Lee
- Section of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Katie M Groom
- Liggins Institute, The University of Auckland, Auckland, New Zealand
- National Women's Health, Auckland City Hospital, Auckland, New Zealand
| |
Collapse
|
31
|
Ferede YA, Bizuneh YB, Workie MM, Admass BA. "Prevalence and associated factors of preoperative anxiety among obstetric patients who underwent cesarean section": A cross-sectional study. Ann Med Surg (Lond) 2022; 74:103272. [PMID: 35198163 PMCID: PMC8844776 DOI: 10.1016/j.amsu.2022.103272] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/08/2022] [Accepted: 01/23/2022] [Indexed: 01/26/2023] Open
Abstract
Background Anxiety is the most common problem in the preoperative period. This anxiety increases postoperative pain, delay healing, and prolong the hospital stay. Among the surgical population, a higher level of preoperative anxiety has been seen in obstetric patients. Objective The aim of this study was to assess the prevalence and associated factors of preoperative anxiety among obstetric patients undergoing cesarean section. Methods An institutional-based cross-sectional study was conducted from January 01, 2021, to May 30, 2021. A total of 376 obstetric patients who underwent cesarean sections were included. Descriptive statistics, cross-tabs, and binary logistic regression analysis were performed to identify the association shivering and independent variables. The strength of the association was presented using an adjusted odds ratio with a 95% confidence interval and a p-value<0.05 was considered as statistically significant state versions of state-trait anxiety inventory scale (S-STAI) were used for this study. Results The overall prevalence rate of preoperative anxiety was 63% (95% CI: 58.2, 68.1). The patient's preoperative mean anxiety score of STAI was (43.81 ± 8.81). There was a high level of preoperative anxiety in patients undergoing emergency cesarean section as compared to elective patients. Patients' age less than 30 years, level of education, and previous anesthesia and surgery exposure were also highly associated with the dependent variable. Conclusion In this study, fear of complications and fear of death result of operation were the most common factors responsible for preoperative anxiety while few patients were anxious about financial loss and osmotic issues. The prevalence rate of preoperative anxiety was 63% among obstetric patients. Preoperative anxiety was highly related to fear of complications and fear of death. Age, Level of education were significantly associated with preoperative anxiety. Previous anesthesia exposure was also significantly associated with anxiety. Preoperative anesthesia visits are important to reduce anxiety.
Collapse
Affiliation(s)
- Yonas Admasu Ferede
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Ethiopia
| | - Yosef Belay Bizuneh
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Ethiopia
| | - Misganaw Mengie Workie
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Ethiopia
| | - Biruk Adie Admass
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
32
|
Doty MS, Chen HY, Ajishegiri O, Sibai BM, Blackwell SC, Chauhan SP. Daily meditation program for anxiety in individuals admitted to the antepartum unit: a multicenter randomized controlled trial (MEDITATE). Am J Obstet Gynecol MFM 2022; 4:100562. [PMID: 35031521 DOI: 10.1016/j.ajogmf.2022.100562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/26/2021] [Accepted: 01/06/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Inpatient antepartum women have higher levels of anxiety than outpatient. Former randomized trials using mindful meditation programs to decrease maternal anxiety have conflicting results; some studies showed a considerable decrease in anxiety levels, whereas others showed no difference. A paucity of trials exist using mindful meditation for maternal anxiety in the inpatient antepartum population; most studies focus on the outpatient clinic population. Because of inpatient acuity and anxiety factors, we conducted a randomized trial to target this population. OBJECTIVE This study aimed to compare anxiety levels on day 4 of either routine care or routine care plus a twice-daily application-based mindful meditation program in women admitted to the antepartum unit. STUDY DESIGN In a multisite randomized trial (ClinicalTrials.gov Identifier: NCT03737279), women admitted to the antepartum units were randomized to either routine care plus educational pamphlets (control arm) or routine care plus a twice-daily application-based mindful meditation program (intervention arm). The inclusion criteria were age of at least 18 years, gestational age of at least 23 weeks, planned inpatient care for >3 days from randomization, and care by our university physician team. The primary outcome was maternal state anxiety level (measured using the validated State-Trait Anxiety Inventory) on day 4 (randomization being day 1). The secondary outcomes included stress (measured using the Perceived Stress Scale) and depression (measured using the Edinburgh Depression Scale) on day 4, latency period from randomization to delivery, patient experience, number of meditation sessions, and total meditation time. A total of 56 women were needed for 90% power to detect a decrease in the primary outcome by 30% in the intervention group, compared with the control group. All women were observed using an intention-to-treat analysis. We compared the continuous variables using the Wilcoxon rank-sum test or t test and the categorical variables using the chi-squared test or the Fisher exact test. RESULTS From March 4, 2019, to December 20, 2019, 412 women were screened for eligibility, 77 women (18.7%) were found eligible, and 56 women (72.7%) were randomized with 28 women in each group. Of note, 96.4% of women completed at least 1 meditation session, and 39.3% of women completed all meditation sessions. The mean score of the anxiety level using the State-Trait Anxiety Inventory on day 4 was not significantly different (P=.24) between the control group (42.0±10.8) and meditation group (37.5±13.1). A decreased anxiety score from day 1 to day 4 was seen in both the control group and meditation group (-4.7 vs -9.4, respectively; P=.12). The rate of abnormal State-Trait Anxiety Inventory scores on day 4 was not significantly different between the control group and meditation group (62% vs 45%, respectively; P=.28). When asked about the experience with the research trial, 88.8% of women in the control group and 89.5% of women in the meditation group reported a positive experience. CONCLUSION Compared with the control group, a twice-daily application-based mindful meditation program for women admitted to the antepartum unit did not considerably decrease the anxiety score on day 4. However, >88% of women in both groups had a positive experience with the nonpharmacologic intervention.
Collapse
Affiliation(s)
- Morgen S Doty
- Obstetrix Maternal-Fetal Medicine Specialists of Houston, Houston, TX (Dr Doty).
| | - Han-Yang Chen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX (Dr Chen, Ms Ajishegiri, and Drs Sibai, Blackwell, and Chauhan)
| | - Oluwadare Ajishegiri
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX (Dr Chen, Ms Ajishegiri, and Drs Sibai, Blackwell, and Chauhan)
| | - Baha M Sibai
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX (Dr Chen, Ms Ajishegiri, and Drs Sibai, Blackwell, and Chauhan)
| | - Sean C Blackwell
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX (Dr Chen, Ms Ajishegiri, and Drs Sibai, Blackwell, and Chauhan)
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX (Dr Chen, Ms Ajishegiri, and Drs Sibai, Blackwell, and Chauhan)
| |
Collapse
|
33
|
Jeličić L, Sovilj M, Bogavac I, Drobnjak A, Gouni O, Kazmierczak M, Subotić M. The Impact of Maternal Anxiety on Early Child Development During the COVID-19 Pandemic. Front Psychol 2021; 12:792053. [PMID: 35002886 PMCID: PMC8728063 DOI: 10.3389/fpsyg.2021.792053] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/02/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Maternal prenatal anxiety is among important public health issues as it may affect child development. However, there are not enough studies to examine the impact of a mother's anxiety on the child's early development, especially up to 1 year. Objective: The present prospective cohort study aimed to examine whether maternal trait anxiety, perceived social support, and COVID-19 related fear impacted speech-language, sensory-motor, and socio-emotional development in 12 months old Serbian infants during the COVID-19 pandemic. Methods: This follow-up study included 142 pregnant women (Time 1) and their children at 12 months (Time 2). Antenatal maternal anxiety and children's development were examined. Maternal anxiety was assessed using the State-Trait Anxiety Inventory (STAI). Child speech-language, sensory-motor, and socio-emotional development were assessed using the developmental scale in the form of an online questionnaire that examined the early psychophysiological child development. Information on socioeconomic factors, child and maternal demographics, clinical factors, and perceived fear of COVID-19 viral infection were collected. Multivariable General Linear Model analysis was conducted, adjusted for demographic, clinical, and coronavirus prenatal experiences, maternal prenatal anxiety levels, perceived social support, speech-language, motor skills, and cognitive and socio-emotional development at the infants' age of 12 months. Results: The study revealed the influence of the COVID-19 pandemic on maternal trait anxiety. The association between selected independent factors and infants' development was found in a demographically unified sample except for employment and the number of children. There was a correlation between all observed developmental functions. Univariate General Linear model statistical analysis indicated that linear models with selected independent factors and covariates could account for 30.9% (Cognition) up to 40.6% (Speech-language) of variability in developmental functions. It turned out that two-way and three-way interactions had a dominant role on models, and STAI-T Level and COVID-19 related fear were present in all interaction terms. Conclusion: Our findings reveal important determinants of child developmental outcomes and underline the impact of maternal anxiety on early child development. These findings lay the groundwork for the following interdisciplinary research on pregnancy and child development to facilitate and achieve positive developmental outcomes and maternal mental health.
Collapse
Affiliation(s)
- Ljiljana Jeličić
- Cognitive Neuroscience Department, Research and Development Institute “Life Activities Advancement Center,”Belgrade, Serbia
- Department of Speech, Language and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology, Belgrade, Serbia
| | - Mirjana Sovilj
- Department of Speech, Language and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology, Belgrade, Serbia
| | - Ivana Bogavac
- Cognitive Neuroscience Department, Research and Development Institute “Life Activities Advancement Center,”Belgrade, Serbia
- Department of Speech, Language and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology, Belgrade, Serbia
| | - And̄ela Drobnjak
- Department of Speech, Language and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology, Belgrade, Serbia
| | - Olga Gouni
- Cosmoanelixis, Prenatal & Life Sciences, Athens, Greece
- Prenatal Sciences Research Institute, Athens, Greece
| | | | - Miško Subotić
- Cognitive Neuroscience Department, Research and Development Institute “Life Activities Advancement Center,”Belgrade, Serbia
| |
Collapse
|
34
|
Cena L, Gigantesco A, Mirabella F, Palumbo G, Camoni L, Trainini A, Stefana A. Prevalence of comorbid anxiety and depressive symptomatology in the third trimester of pregnancy: Analysing its association with sociodemographic, obstetric, and mental health features. J Affect Disord 2021; 295:1398-1406. [PMID: 34583842 DOI: 10.1016/j.jad.2021.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 08/09/2021] [Accepted: 09/12/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Little is known about the prevalence of comorbid anxiety and depression (CAD) during pregnancy and its risk factors. The aims of this study are to determine the prevalence of CAD in the third trimester of pregnancy and analyse its association with socio-demographic, obstetric, and mental health features. METHODS In a sample of 934 Italian pregnant women, CAD was defined as having (1) a score of ≥ 10 on the EPDS - depression subscale and/or on the PHQ-9, and (2) a score of ≥ 40 on the State-Trait Anxiety Inventory State and/or a score of ≥ 6 on the EPDS - anxiety subscale. Logistic regression analyses were used to identify socio-demographic, obstetrics, and mental health risk factors of CAD. RESULTS The prevalence of CAD was 6.8%. Age between 30 and 35 years (OR=3.01, 95% CI: 1.22-7.45) compared to younger age, current sleep disorders (OR=7.88, 95% CI: 3.83-16.23), and preconception mood disorders (OR=2.76, 95% CI: 1.31-5.84) were associated with higher odds of CAD. Conversely, the presence of no or few economic problems (OR=0.21, 95% CI: 0.07-0.65; OR=0.26, 95% CI: 0.09-0.77) and the perception of enough or more than enough practical support from friends or relatives (OR=0.32, 95% CI: 0.13-0.80; OR=0.22, 95% CI: 0.09-0.53) were associated with lower odds of developing CAD. LIMITATIONS The cross-sectional design; the use of self-report questionnaires. CONCLUSION CAD is relatively common among third-trimester antepartum women. The provision of economic/practical support may reduce CAD prevalence and its direct and indirect costs.
Collapse
Affiliation(s)
- Loredana Cena
- Observatory of Perinatal Clinical Psychology, Department of Clinical and Experimental Sciences, Section of Neuroscience, University of Brescia, viale Europa 11, 25123 Brescia, Italy.
| | - Antonella Gigantesco
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Fiorino Mirabella
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Gabriella Palumbo
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Laura Camoni
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Alice Trainini
- Observatory of Perinatal Clinical Psychology, Department of Clinical and Experimental Sciences, Section of Neuroscience, University of Brescia, viale Europa 11, 25123 Brescia, Italy
| | - Alberto Stefana
- Observatory of Perinatal Clinical Psychology, Department of Clinical and Experimental Sciences, Section of Neuroscience, University of Brescia, viale Europa 11, 25123 Brescia, Italy
| |
Collapse
|
35
|
Stock SJ, Horne M, Bruijn M, White H, Heggie R, Wotherspoon L, Boyd K, Aucott L, Morris RK, Dorling J, Jackson L, Chandiramani M, David A, Khalil A, Shennan A, Baaren GJV, Hodgetts-Morton V, Lavender T, Schuit E, Harper-Clarke S, Mol B, Riley RD, Norman J, Norrie J. A prognostic model, including quantitative fetal fibronectin, to predict preterm labour: the QUIDS meta-analysis and prospective cohort study. Health Technol Assess 2021; 25:1-168. [PMID: 34498576 DOI: 10.3310/hta25520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The diagnosis of preterm labour is challenging. False-positive diagnoses are common and result in unnecessary, potentially harmful treatments (e.g. tocolytics, antenatal corticosteroids and magnesium sulphate) and costly hospital admissions. Measurement of fetal fibronectin in vaginal fluid is a biochemical test that can indicate impending preterm birth. OBJECTIVES To develop an externally validated prognostic model using quantitative fetal fibronectin concentration, in combination with clinical risk factors, for the prediction of spontaneous preterm birth and to assess its cost-effectiveness. DESIGN The study comprised (1) a qualitative study to establish the decisional needs of pregnant women and their caregivers, (2) an individual participant data meta-analysis of existing studies to develop a prognostic model for spontaneous preterm birth within 7 days in women with symptoms of preterm labour based on quantitative fetal fibronectin and clinical risk factors, (3) external validation of the prognostic model in a prospective cohort study across 26 UK centres, (4) a model-based economic evaluation comparing the prognostic model with qualitative fetal fibronectin, and quantitative fetal fibronectin with cervical length measurement, in terms of cost per QALY gained and (5) a qualitative assessment of the acceptability of quantitative fetal fibronectin. DATA SOURCES/SETTING The model was developed using data from five European prospective cohort studies of quantitative fetal fibronectin. The UK prospective cohort study was carried out across 26 UK centres. PARTICIPANTS Pregnant women at 22+0-34+6 weeks' gestation with signs and symptoms of preterm labour. HEALTH TECHNOLOGY BEING ASSESSED Quantitative fetal fibronectin. MAIN OUTCOME MEASURES Spontaneous preterm birth within 7 days. RESULTS The individual participant data meta-analysis included 1783 women and 139 events of spontaneous preterm birth within 7 days (event rate 7.8%). The prognostic model that was developed included quantitative fetal fibronectin, smoking, ethnicity, nulliparity and multiple pregnancy. The model was externally validated in a cohort of 2837 women, with 83 events of spontaneous preterm birth within 7 days (event rate 2.93%), an area under the curve of 0.89 (95% confidence interval 0.84 to 0.93), a calibration slope of 1.22 and a Nagelkerke R 2 of 0.34. The economic analysis found that the prognostic model was cost-effective compared with using qualitative fetal fibronectin at a threshold for hospital admission and treatment of ≥ 2% risk of preterm birth within 7 days. LIMITATIONS The outcome proportion (spontaneous preterm birth within 7 days of test) was 2.9% in the validation study. This is in line with other studies, but having slightly fewer than 100 events is a limitation in model validation. CONCLUSIONS A prognostic model that included quantitative fetal fibronectin and clinical risk factors showed excellent performance in the prediction of spontaneous preterm birth within 7 days of test, was cost-effective and can be used to inform a decision support tool to help guide management decisions for women with threatened preterm labour. FUTURE WORK The prognostic model will be embedded in electronic maternity records and a mobile telephone application, enabling ongoing data collection for further refinement and validation of the model. STUDY REGISTRATION This study is registered as PROSPERO CRD42015027590 and Current Controlled Trials ISRCTN41598423. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 52. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Sarah J Stock
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Margaret Horne
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Merel Bruijn
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Helen White
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Robert Heggie
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lisa Wotherspoon
- Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Kathleen Boyd
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lorna Aucott
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Rachel K Morris
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jon Dorling
- Department of Neonatology, IWK Health Centre, Halifax, NS, Canada
| | - Lesley Jackson
- Department of Neonatology, Queen Elizabeth Hospital, Glasgow, UK
| | - Manju Chandiramani
- Department of Obstetrics and Gynaecology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Anna David
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Asma Khalil
- Department of Fetal Medicine, St George's Hospital, St George's, University of London, London, UK
| | - Andrew Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Gert-Jan van Baaren
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | - Tina Lavender
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ewoud Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Ben Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Richard D Riley
- Centre for Prognosis Research, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jane Norman
- Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - John Norrie
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
36
|
Trends of Perinatal Stress, Anxiety, and Depression and Their Prediction on Postpartum Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179307. [PMID: 34501906 PMCID: PMC8431252 DOI: 10.3390/ijerph18179307] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 01/22/2023]
Abstract
Perinatal stress, anxiety, and depression impacts not only women but also their child(ren). The purpose of this longitudinal study is to explore trends of stress, anxiety, and depressive symptoms from pregnancy to postpartum and understand predictions of stress and anxiety on postpartum depression. One-hundred-fifty-six women at 23-28 weeks gestation (T1), 147 at 32-36 weeks gestation (T2), 129 at over 36 weeks gestation (T3), and 83 at postpartum (T4) completed study surveys. The Perceived Stress Scale, Center for Epidemiologic Studies Depression scale, and State-Trait Anxiety Inventory were used to measure stress, depressive symptoms, and anxiety. Descriptive statistics, Pearson and Spearman's correlation, and Generalized Estimating Equation were applied to analyze the data. Results showed that levels of anxiety and depressive symptoms increased from 24 weeks gestation to postpartum, whereas stress levels decreased during pregnancy but increased in postpartum. Over half of women experienced anxiety symptoms, especially during late pregnancy and postpartum. Stress, anxiety, and depressive symptoms were inter-correlated. Notably, women at late pregnancy and postpartum were prone to stress, anxiety, and depression. Prenatal anxiety could predict postpartum depressive symptoms. Active assessment and management of stress, anxiety, and depression is needed and should begin from early pregnancy and continue until postpartum.
Collapse
|
37
|
Dufford AJ, Salzwedel AP, Gilmore JH, Gao W, Kim P. Maternal trait anxiety symptoms, frontolimbic resting-state functional connectivity, and cognitive development in infancy. Dev Psychobiol 2021; 63:e22166. [PMID: 34292595 PMCID: PMC10775911 DOI: 10.1002/dev.22166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 06/13/2021] [Accepted: 06/22/2021] [Indexed: 11/07/2022]
Abstract
Exposure to maternal anxiety symptoms during infancy has been associated with difficulties in development and greater risk for developing anxiety later in life. Although previous studies have examined associations between prenatal maternal distress, infant brain development, and developmental outcomes, it is still largely unclear if there are associations between postnatal anxiety, infant brain development, and cognitive development in infancy. In this study, we used resting-state functional magnetic resonance imaging to examine the association between maternal anxiety symptoms and resting-state functional connectivity in the first year of life. We also examine the association between frontolimbic functional connectivity and infant cognitive development. The sample consisted of 21 infants (mean age = 24.15 months, SD = 4.17) that were scanned during their natural sleep using. We test the associations between maternal trait anxiety symptoms and amygdala-anterior cingulate cortex (ACC) functional connectivity, a neural circuit implicated in early life stress exposure. We also test the associations between amygdala-ACC connectivity and cognitive development. We found a significant negative association between maternal trait anxiety symptoms and left amygdala-right ACC functional connectivity (p < .05, false discovery rate corrected). We found a significant negative association between left amygdala-right ACC functional connectivity and infant cognitive development (p < .05). These findings have potential implications for understanding the role of postpartum maternal anxiety symptoms in functional brain and cognitive development in infancy.
Collapse
Affiliation(s)
| | - Andrew P. Salzwedel
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - John H. Gilmore
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Wei Gao
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Pilyoung Kim
- Department of Psychology, University of Denver, Denver, Colorado, USA
| |
Collapse
|
38
|
Tan HS, Agarthesh T, Tan CW, Sultana R, Chen HY, Chua TE, Sng BL. Perceived stress during labor and its association with depressive symptomatology, anxiety, and pain catastrophizing. Sci Rep 2021; 11:17005. [PMID: 34417541 PMCID: PMC8379208 DOI: 10.1038/s41598-021-96620-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 08/13/2021] [Indexed: 12/24/2022] Open
Abstract
Perceived stress is a dimension of the maternal stress response, however little data is available on perceived stress levels and its associated psychological risk factors during labor. In this secondary data analysis from a prospective study evaluating epidural regimens, we investigated the potential associations between depressive symptomatology, anxiety, and pain catastrophizing with perceived stress during labor. Healthy nulliparous adult women with term singleton pregnancies requesting for epidural analgesia in early labor were included. Assessments were administered after epidural analgesia and adequate pain relief were achieved. Perceived stress (Perceived Stress Scale, PSS, high PSS ≥ 16), depressive symptomatology (Edinburgh Postnatal Depression Scale, EPDS, high EPDS ≥ 10), and pain catastrophizing (Pain Catastrophizing Scale, PCS, high total PCS ≥ 25) were assessed as categorical variables. Additionally, anxiety (State-trait Anxiety Inventory, STAI), PCS total and its subscales (rumination, magnification and helplessness) were analyzed as continuous variables. Univariate and multivariable logistic regression models were used to identify factors associated with high PSS. Of 801 women included, 411 (51.9%) had high PSS. High EPDS (OR 2.16, 95%CI 1.36–3.44), increasing trait anxiety (OR 1.17, 95%CI 1.14–1.20), and increasing pain magnification (OR 1.12, 95%CI 1.05–1.19) were independently associated with high PSS. Depressive symptomatology, trait anxiety, and pain magnification were associated with perceived stress during labor, providing impetus for future research aimed at detecting and alleviating stress and its psychological or pain association factors.
Collapse
Affiliation(s)
- Hon Sen Tan
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore, Singapore
| | - T Agarthesh
- Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Chin Wen Tan
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore, Singapore.,Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Helen Yu Chen
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Pediatrics Academic Clinical Program, Duke-NUS Medical School, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Tze-Ern Chua
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Pediatrics Academic Clinical Program, Duke-NUS Medical School, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Ban Leong Sng
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore, Singapore. .,Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
| |
Collapse
|
39
|
Tsakiridis I, Dagklis T, Mamopoulos A, Athanasiadis A, Pearson R, Papazisis G. Antenatal depression and anxiety during the COVID-19 pandemic: a cross-sectional study in pregnant women from routine health care contact in Greece. J Perinat Med 2021; 49:656-663. [PMID: 33725757 DOI: 10.1515/jpm-2020-0473] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/27/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The impact of the COVID-19 pandemic and the public health measures introduced to control it, on mental health, is largely unknown. Research conducted during past epidemics found that pregnant women are more vulnerable psychologically. The aim of this study was to investigate antenatal depressive and anxiety symptoms during this pandemic in Greece. METHODS All women receiving routine antenatal care, during a three-month period, starting one week after the total lockdown in Greece, in a University department, were asked to fill in two questionnaires, the Edinburg Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI). RESULTS Overall, 505 women (93.3% of the eligible population) agreed to participate. The prevalence of antenatal depression (EPDS score≥13) in the population of the study was 13.5%. Unplanned pregnancy (OR: 2.447; 95% CI: 1.235-4.846), smoking (OR: 2.268; 95% CI: 1.166-4.411) and antenatal anxiety (OR: 5.074; 95% CI: 2.898-8.883) increased the risk of antenatal depression during the COVID-19 pandemic. State (current)-anxiety affected 34.1% of the participants, whereas Trait (lifetime)-anxiety affected 15.8%. The State-anxiety score (median) was significantly higher than the Trait-anxiety (median) (41 vs. 36; p<0.001), revealing an increase in the levels of anxiety in the pandemic, while there was also a positive linear correlation between the two scales (rho=0.592; p<0.001). CONCLUSIONS The unprecedented situation of the COVID-19 pandemic has increased anxiety, but not depression levels of pregnant women in Greece. Population level interventions to address adverse effects on anxiety status in the initial phases of similar situations may be helpful in the future.
Collapse
Affiliation(s)
- Ioannis Tsakiridis
- 3rd Department of Obstetrics and Gynaecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Themistoklis Dagklis
- 3rd Department of Obstetrics and Gynaecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Mamopoulos
- 3rd Department of Obstetrics and Gynaecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Athanasiadis
- 3rd Department of Obstetrics and Gynaecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Rebecca Pearson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Georgios Papazisis
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
40
|
McDonald HM, Sherman KA, Kasparian NA. A mediated model of mindful awareness, emotion regulation, and maternal mental health during pregnancy and postpartum. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.1080/00049530.2021.1908846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - Nadine A. Kasparian
- Cincinnati Children’s Centre for Heart Disease and Mental Health, Heart Institute and the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
41
|
Dommergues M, Candilis D, Becerra L, Thoueille E, Cohen D, Viaux-Savelon S. Childbirth and motherhood in women with motor disability due to a rare condition: an exploratory study. Orphanet J Rare Dis 2021; 16:176. [PMID: 33849607 PMCID: PMC8045243 DOI: 10.1186/s13023-021-01810-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/31/2021] [Indexed: 11/28/2022] Open
Abstract
Background Rare diseases may result in motor impairment, which in turn may affect parenthood. Our purpose was to evaluate perinatal outcomes, parenting needs, mother-infant interactions and infant development in a set of volunteer women with motor impairment due to a rare disease. In a parenting support institution, we recruited a consecutive series of 22 volunteer pregnant women or young mothers, recorded perinatal outcomes, and followed mother-infant interaction and relationship and infant development up to 14 months postpartum. Cases with intellectual or psychic disability were not included. Results There were 11 genetic diseases (2 Spinal Muscular Atrophy, 1 Charcot-Marie-Tooth, 1 autosomal dominants myopathy, 1 mitochondrial disease, 2 Elhers-Danlos, 1 Friedreich ataxia, 1 spinocerebellar ataxia, 1 tetrahydrobiopterine deficiency,1 Ectrodactyly), and 11 rare non-genetic conditions (2 spine tumors, 2 strokes, 1 juvenile chronic arthritis, 3 birth injuries, 1 inflammatory myopathy, 1 congenital amputation, and 1 traumatic amputation). These resulted in 10 impairments of four limbs, 4 impairments of both lower limbs, 7 unilateral impairments, and one distal tremor. Social deprivation Epices score, Cutrona social support scale, Edinburg Postnatal Depression scale, and Spielberger State/Trait Anxiety Inventory were unremarkable. Perinatal outcome: 4 gestational diabetes, 1 pre-eclampsia, 9 caesareans, 6 assisted and 7 spontaneous vaginal deliveries, 20 term live-births and 2 premature deliveries (35–36 weeks). Twelve women declared they were self-sufficient for daily activities; six declared they were self-sufficient to provide basic care to their baby. Distribution of the Brunet-Lezine child development score was normal. The parent-infant relationship global assessment scale (PIR-GAS) was well adapted in 2 cases, adapted in 8, perturbed in 7, significantly perturbed in 2, and distressed in 3 (mean 71.8; 95% CI 49.6–93.9). This was unrelated to any somatic or emotional characteristics of the participants. Coding interactive behavior revealed that infant engagement was lower and infant avoidance greater than in controls (p < 0.05). Conclusion Infant development was normal, but mother-infant interactions were altered in half of the participants independently from the degree of motor impairment, underscoring the need for parenting support, even for parents who are self-sufficient in daily activities.
Collapse
Affiliation(s)
- Marc Dommergues
- Department of Obstetrics and Gynecology, Hopital Pitié Salpêtrière APHP and Sorbonne Université, 83 Boulevard de l'Hopital, 75013, Paris, France.
| | | | - Ludivine Becerra
- Service d'Aide à la Parentalité des Personnes en Situation de Handicap, Paris, France
| | - Edith Thoueille
- Service d'Aide à la Parentalité des Personnes en Situation de Handicap, Paris, France
| | - David Cohen
- Child Psychiatry, Hopital Pitié Salpêtrière APHP and Sorbonne Université, Paris, France
| | - Sylvie Viaux-Savelon
- Child Psychiatry, Hopital Pitié Salpêtrière APHP and Sorbonne Université, Paris, France
| |
Collapse
|
42
|
Akbas M, Koyuncu FM, Bülbül Y, Artunc-Ulkumen B, Çetin A. The impact of invasive prenatal testing on anxiety and sleep quality in pregnant women with a screen-positive result for aneuploidy. J Psychosom Obstet Gynaecol 2021; 42:15-21. [PMID: 31899650 DOI: 10.1080/0167482x.2019.1708320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Prenatal anxiety has negative effects on pregnancy and neonate. Both screening tests and invasive diagnostic tests are associated with elevated anxiety level. But a normal fetal karyotype result could improve the anxiety level in high-risk patients. We hypothesized that patients who prefer follow-up without karyotyping may experience increased anxiety and sleep impairment until delivery. Our aim was to determine the effect of invasive diagnostic test decision on anxiety and sleep quality in women with a positive screening result. METHODS 132 women were included for the study and three groups were described. The invasive group consisted of women who underwent invasive procedure after a screen-positive test result, the follow-up group consisted of women who preferred non-invasive follow-up after a screen-positive result and the control group consisted of women with screen-negative test results. Participants were evaluated with the State-Trait Anxiety Inventory (STAI) and the Pittsburgh Sleep Quality Index (PSQI) after genetic counseling. They were asked for completing the same questionnaires in the third trimester to establish the course of anxiety and sleep quality throughout pregnancy. RESULTS STAI scores were significantly higher in both screen-positive groups than in the control group in the first evaluation (p < 0.001). STAI scores decreased in the invasive group and controls while PSQI scores did not significantly change during the course of the pregnancy. However, the anxiety level and sleep quality were worsened over time in the follow-up group. CONCLUSION Screen-positive women who preferred to follow up had higher anxiety level and worse sleep quality in the later stages of pregnancy. We concluded that invasive prenatal diagnostic tests could improve anxiety and sleep quality in pregnant women with a screen-positive result for aneuploidy.
Collapse
Affiliation(s)
- Murat Akbas
- Division of Perinatology, Department of Obstetrics and Gynecology, Manisa Celal Bayar University, Manisa, Turkey
| | - Faik Mumtaz Koyuncu
- Division of Perinatology, Department of Obstetrics and Gynecology, Manisa Celal Bayar University, Manisa, Turkey
| | - Yeşim Bülbül
- Division of Perinatology, Department of Obstetrics and Gynecology, Manisa Celal Bayar University, Manisa, Turkey
| | - Burcu Artunc-Ulkumen
- Division of Perinatology, Department of Obstetrics and Gynecology, Manisa Celal Bayar University, Manisa, Turkey
| | - Alptekin Çetin
- Department of Psychiatry, Uskudar University, NP Istanbul Hospital, Istanbul, Turkey
| |
Collapse
|
43
|
Tan CW, Tan HS, Sultana R, Chui A, Chua TE, Chen H, Sng BL. Association of Childbirth Pain with Postnatal Depressive and Anxiety Disorders in Nulliparous Parturients: A Prospective Study. Neuropsychiatr Dis Treat 2021; 17:2625-2636. [PMID: 34413647 PMCID: PMC8370488 DOI: 10.2147/ndt.s321367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/01/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE There is limited knowledge on the relationship between postnatal depression and childbirth pain characteristics associated with childbirth. We investigated whether the characteristics of childbirth pain, as assessed by Short-form-McGill Pain Questionnaire-2 (SF-MPQ-2), were associated with postnatal anxiety and depressive disorders. PATIENTS AND METHODS Nulliparous parturients who received labor epidural analgesia (LEA) and delivered in our institution were invited to have a Mini-International Neuropsychiatric Interview (MINI) assessment following their 5-9 weeks post-delivery follow-up phone survey of a larger study. Parturients' demographics, pre-delivery questionnaires on pain and psychological vulnerabilities, LEA data, maternal and neonatal outcomes, postnatal follow-up survey on pain and psychological vulnerabilities, pain and breastfeeding were collected accordingly. The primary outcome was the binary variable (yes/no) of the presence of postnatal depression and/or anxiety disorders based on the post-delivery MINI assessment. RESULTS Among the 107 parturients who participated in the post-delivery MINI assessment, a total of 40 (42.5%) patients were found to have postnatal anxiety and depressive disorders. A greater pre-delivery SF-MPQ-2 neuropathic pain mean subscale score (adjusted odds ratio (OR) 1.32, 95% CI 1.00-1.73, p=0.0482) and greater post-delivery Edinburgh Postnatal Depression Scale (EPDS) at 5-9 weeks post-delivery (adjusted OR 1.30, 95% CI 1.13-1.50, p=0.0002) were independently associated with the presence of postnatal anxiety and/or depressive disorders (receiver operating characteristic (ROC) = 0.7489). CONCLUSION Patients with greater pre-delivery neuropathic pain and higher EPDS scores at 5-9 weeks post-delivery are more likely to have postnatal depression and/or anxiety disorders, suggesting possible associations between pain and psychological vulnerability in the development of postnatal mental disorders.
Collapse
Affiliation(s)
- Chin Wen Tan
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore.,Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Hon Sen Tan
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore.,Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Anne Chui
- Lee Kong Chian School of Medicine, Singapore
| | - Tze-Ern Chua
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore.,Pediatrics Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Helen Chen
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore.,Pediatrics Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Ban Leong Sng
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore.,Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| |
Collapse
|
44
|
Longitudinal study on prenatal depression and anxiety during the COVID-19 pandemic. Arch Womens Ment Health 2021; 24:1027-1036. [PMID: 34159467 PMCID: PMC8219177 DOI: 10.1007/s00737-021-01152-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/02/2021] [Indexed: 01/27/2023]
Abstract
Several studies have reported the negative impact of the COVID-19 pandemic context on mental health. Given that pregnant women constitute a vulnerable group, they may be at greater risk for developing psychopathological symptoms due to the confinement. The current study aimed to longitudinally analyze the presence and evolution of indicators of depression and anxiety in pregnant and non-pregnant women, and to identify the differential effects of social isolation or distancing measures on these groups. Participants were 105 pregnant and 105 non-pregnant Argentine adult women. They completed the Beck Depression Inventory-II, the State-Trait Anxiety Inventory, and closed-ended questions on sociodemographic factors, at four different times. Results showed a progressive increase in anxiety and depressive symptoms in the first 50 days of confinement in both groups, and a slight decrease after approximately 150 days. Pregnant women presented a more pronounced initial increase in symptoms, and a weaker decrease at the last wave, compared to the non-pregnant. Results suggest that the pandemic context produces a moderate negative early response and that the initial flexibilizations of sanitary measures (50 days) did not slow down the progression of symptoms (even less in pregnant women). In conclusion, being pregnant could be an extra risk factor for the development of psychopathological symptoms during this pandemic. The particular vulnerability of pregnant women and the associated potential negative effects both on them and on their offspring underline the importance of perinatal health policies aimed at prevention and treatment of possible future consequences.
Collapse
|
45
|
Tuovinen S, Lahti-Pulkkinen M, Girchenko P, Heinonen K, Lahti J, Reynolds RM, Hämäläinen E, Villa PM, Kajantie E, Laivuori H, Raikkonen K. Maternal antenatal stress and mental and behavioral disorders in their children. J Affect Disord 2021; 278:57-65. [PMID: 32950844 DOI: 10.1016/j.jad.2020.09.063] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Maternal antenatal stress, including symptoms of depression, anxiety and perceived stress, is associated with mental and behavioral problems in children. Whether it is associated with child mental and behavioral disorders remains uncertain. We examined if maternal antenatal symptoms of depression, anxiety and perceived stress were associated with mental and behavioral disorders in their children, if the associations varied according to gestational week, stress type, fluctuating or consistently high symptoms, and if they were driven by maternal or paternal lifetime mood or anxiety disorders. METHODS 3365 mothers participating in the Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction (PREDO) study completed the Center for Epidemiologic Studies Depression Scale, the State Anxiety Inventory and the Perceived Stress Scale up to 14 times throughout pregnancy. The Care Register for Health Care provided data on mental and behavioral (including neurodevelopmental) disorders for their children from birth (11/07/2006-07/24/2010) until 12/31/2016 and for parental lifetime mood and anxiety disorders until 12/31/2016. RESULTS The hazard of any childhood mental and behavioral disorder (HR=1.91, 95% CI: 1.39-2.51) was significantly higher for children whose mothers reported consistently high in comparison to consistently low levels of all types of stress throughout pregnancy. The associations remained significant when adjusted for maternal and paternal lifetime mood and anxiety disorders (and their comorbidity and timing and mood disorder type). CONCLUSION Maternal antenatal stress is associated with higher risk of childhood mental and behavioral disorders. Efforts to reduce maternal antenatal stress should be given a high priority to improve child mental health.
Collapse
Affiliation(s)
- Soile Tuovinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland.
| | - Marius Lahti-Pulkkinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Polina Girchenko
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Kati Heinonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Jari Lahti
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Rebecca M Reynolds
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Esa Hämäläinen
- Department of Clinical Chemistry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pia M Villa
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eero Kajantie
- National Institute for Health and Welfare, Helsinki, Finland; PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Clinical and Molecular Medicine, Norwegian University for Science and Technology, Trondheim, Norway
| | - Hannele Laivuori
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland; Department of Obstetrics and Gynecology, Tampere University Hospital and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Katri Raikkonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| |
Collapse
|
46
|
Harvey MW, Braun B, Ertel KA, Pekow PS, Markenson G, Chasan-Taber L. Stress and Anxiety are Associated with Lower Gestational Weight Gain in Hispanic Women. Womens Health Issues 2020; 30:409-415. [PMID: 32994129 PMCID: PMC7704913 DOI: 10.1016/j.whi.2020.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 08/12/2020] [Accepted: 08/18/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Prior studies indicate that inadequate and excessive gestational weight gain (GWG) are associated with poor maternal and infant outcomes, and that stress and anxiety may contribute to GWG. However, these studies often failed to use validated measures of stress and anxiety, measured only total GWG, and were limited to largely non-Hispanic White populations. We explored the association between stress and anxiety and GWG. METHODS We used data from 1,308 participants in Proyecto Buena Salud, a prospective cohort of predominantly Puerto Rican women 18-40 years of age (2006-2012). We measured stress with the Perceived Stress Scale and anxiety with the State-Trait Anxiety Scale, and abstracted GWG from medical records. RESULTS The average GWG was 31.0 ± 16.1 pounds. More than one-half of participants (51.8%) exceeded Institute of Medicine guidelines for GWG. After adjusting for age and pre-pregnancy body mass index, women in the highest quartiles of stress and anxiety in early pregnancy had approximately 4 lbs lower GWG (β = -3.89; SE = 1.54; p = .012 and β = -4.37; SE = 1.54; p = .005, respectively) as compared with those in the lowest quartiles. Similarly, women in the highest quartiles of mid/late pregnancy stress and anxiety had lower GWG (β = -3.84 lbs; SE = 1.39; p = .006, and β = -3.51 lbs; SE = 1.38; p = .011, respectively) and a lower rate of GWG in the second and third trimesters (β = -0.117 lbs/week; SE = 0.044; p = .008 and β = -0.116 lbs/week; SE = 0.043; p = .007, respectively), compared with those in the lowest quartiles. CONCLUSIONS High stress and anxiety were associated with lower GWG. Interventions to decrease stress and anxiety during pregnancy should include counseling on maintaining healthy GWG.
Collapse
Affiliation(s)
- Megan W Harvey
- Department of Health Sciences, Springfield College, Springfield, Massachusetts.
| | - Barry Braun
- Department of Health and Exercise Science, Colorado State University, Fort Collins, Colorado
| | - Karen A Ertel
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts
| | - Penelope S Pekow
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts
| | - Glenn Markenson
- Obstetrics & Gynocology, Boston University School of Medicine, Boston, Massachusetts
| | - Lisa Chasan-Taber
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts
| |
Collapse
|
47
|
Cena L, Mirabella F, Palumbo G, Gigantesco A, Trainini A, Stefana A. Prevalence of maternal antenatal anxiety and its association with demographic and socioeconomic factors: A multicentre study in Italy. Eur Psychiatry 2020; 63:e84. [PMID: 32892763 PMCID: PMC7576533 DOI: 10.1192/j.eurpsy.2020.82] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/16/2020] [Accepted: 08/27/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Maternal antenatal anxiety is very common, and despite its short- and long-term effects on both mothers and fetus outcomes, it has received less attention than it deserves in scientific research and clinical practice. Therefore, we aimed to estimate the prevalence of state anxiety in the antenatal period, and to analyze its association with demographic and socioeconomic factors. METHODS A total of 1142 pregnant women from nine Italian healthcare centers were assessed through the state scale of the State-Trait Anxiety Inventory and a clinical interview. Demographic and socioeconomic factors were also measured. RESULTS The prevalence of anxiety was 24.3% among pregnant women. There was a significantly higher risk of anxiety in pregnant women with low level of education (p < 0.01), who are jobless (p < 0.01), and who have economic problems (p < 0.01). Furthermore, pregnant women experience higher level of anxiety when they have not planned the pregnancy (p < 0.01), have a history of abortion (p < 0.05), and have children living at the time of the current pregnancy (p < 0.05). CONCLUSION There exists a significant association between maternal antenatal anxiety and economic conditions. Early evaluation of socioeconomic status of pregnant women and their families in order to identify disadvantaged situations might reduce the prevalence of antenatal anxiety and its direct and indirect costs.
Collapse
Affiliation(s)
- L. Cena
- Department of Clinical and Experimental Sciences, Section of Neuroscience, Observatory of Perinatal Clinical Psychology, University of Brescia, viale Europa 11, Brescia25123, Italy
| | - F. Mirabella
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Viale Regina Elena 299, Rome00161, Italy
| | - G. Palumbo
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Viale Regina Elena 299, Rome00161, Italy
| | - A. Gigantesco
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Viale Regina Elena 299, Rome00161, Italy
| | - A. Trainini
- Department of Clinical and Experimental Sciences, Section of Neuroscience, Observatory of Perinatal Clinical Psychology, University of Brescia, viale Europa 11, Brescia25123, Italy
| | - A. Stefana
- Department of Clinical and Experimental Sciences, Section of Neuroscience, Observatory of Perinatal Clinical Psychology, University of Brescia, viale Europa 11, Brescia25123, Italy
| |
Collapse
|
48
|
Zsido AN, Teleki SA, Csokasi K, Rozsa S, Bandi SA. Development of the short version of the spielberger state-trait anxiety inventory. Psychiatry Res 2020; 291:113223. [PMID: 32563747 DOI: 10.1016/j.psychres.2020.113223] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Abstract
The Spielberger State-Trait Anxiety Inventory (STAI) has been widely used to measure the state and trait components of anxiety. We sought to develop a short, yet reliable and valid form of these scales for use in circumstances where the full-form is not feasible. We abbreviated the scales using item response theory analyses to retain the items that could discriminate the best among participants. One sample (N = 922) completed the state scale, a second sample (N = 2227) completed the trait scale, while a third sample (N = 250) completed the short forms. Our participants completed the Hungarian version of STAI alongside other measures to observe external validity. We calculated cut-off scores for the state (>9.5,) and trait (>13.5) scales. A total of 19.5% and 20.1% of the respondents reached the cut-off scores. The five-item short forms of STAI had sound psychometric properties that are comparable to those obtained on the full-form. The external validity of the scales is also demonstrated. We report detailed descriptive statistics that could be used in further studies as standards. The short scales are reliable measures that could be used in clinical screening and behavioural research; especially where practical considerations preclude the use of a longer questionnaire.
Collapse
Affiliation(s)
- Andras N Zsido
- Institute of Psychology, University of Pécs, Pécs, Hungary.
| | | | | | - Sandor Rozsa
- Departments of Psychiatry, Genetics & Psychology, Washington University, St. Louis, USA
| | | |
Collapse
|
49
|
Hall HG, Cant R, Munk N, Carr B, Tremayne A, Weller C, Fogarty S, Lauche R. The effectiveness of massage for reducing pregnant women's anxiety and depression; systematic review and meta-analysis. Midwifery 2020; 90:102818. [PMID: 32827841 DOI: 10.1016/j.midw.2020.102818] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 08/01/2020] [Accepted: 08/14/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To critically appraise and synthesize the best available evidence on the effectiveness of massage to reduce antenatal women's anxiety and/ or depression. DESIGN Systematic review with meta-analysis PARTICIPANTS, INTERVENTIONS: Pregnant women over the age of 18 years who receive massage interventions. MEASUREMENTS AND FINDINGS Eight studies were included in the review; seven were randomized controlled trials. Data were collected via pregnant women's self-reported ratings of anxiety or depression using validated tools. Meta-analysis of four studies revealed a moderate effect of massage therapy on women's depressive symptoms as measured by the Center for Epidemiologic Studies Depression Scale (CES-D) (MD = -5.95, 95%CI = -8.11 to -3.80, I2 = 0%) compared with usual care. A moderate effect of massage interventions on women's anxiety were also found based on five studies using various measures (SMD = -0.59, 95%CI = -1.06 to -0.12, I2 = 75%) when compared with usual care. However, none of the trials had a low risk of bias. KEY CONCLUSIONS Non-pharmacologic treatments for mental health symptoms are an important option for women to use during pregnancy. As shown in meta-analysed data, massage therapy might be more effective in reducing pregnant women's anxiety and depression than usual care, although the current results may be prone to bias. Further high-quality research is required to fully evaluate the impact of massage therapy on pregnant women's mental health symptoms in the immediate and also longer term. IMPLICATIONS FOR PRACTICE Massage therapy may be an acceptable and feasible approach for pregnant women to employ to reduce their anxiety and depressive symptoms. More research evidence examining the safety and effectiveness of massage is required before practice recommendations can be made.
Collapse
Affiliation(s)
- H G Hall
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing & Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankston Victoria 3199, Australia; Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney, NSW, Australia.
| | - R Cant
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing & Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankston Victoria 3199, Australia
| | - N Munk
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney, NSW, Australia; Indiana University School of Health & Human Sciences, IUPUI, Indianapolis, USA
| | - B Carr
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing & Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankston Victoria 3199, Australia
| | - A Tremayne
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing & Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankston Victoria 3199, Australia
| | - C Weller
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing & Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankston Victoria 3199, Australia
| | - S Fogarty
- Western Sydney University, School of Medicine, Penrith NSW, Australia
| | - R Lauche
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing & Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankston Victoria 3199, Australia; Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney, NSW, Australia; Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, Bamberg, Germany; National Centre in Naturopathic Medicine, Southern Cross University, Lismore NSW, Australia
| |
Collapse
|
50
|
Phua DY, Chen H, Chong YS, Gluckman PD, Broekman BFP, Meaney MJ. Network Analyses of Maternal Pre- and Post-Partum Symptoms of Depression and Anxiety. Front Psychiatry 2020; 11:785. [PMID: 32848949 PMCID: PMC7424069 DOI: 10.3389/fpsyt.2020.00785] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/22/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Maternal mental health problems often develop prenatally and predict post-partum mental health. However, the circumstances before and following childbirth differ considerably. We currently lack an understanding of dynamic variation in the profiles of depressive and anxiety symptoms over the perinatal period. METHODS Depressive and anxiety symptoms were self-reported by 980 women at 26-week pregnancy and 3 months post-partum. We used network analysis of depressive and anxiety symptoms to investigate if the symptoms network changed during and after pregnancy. The pre- and post-partum depressive-anxiety symptom networks were assessed for changes in structure, unique symptom-symptom interactions, central and bridging symptoms. We also assessed if central symptoms had stronger predictive effect on offspring's developmental outcomes outcomes at birth and 24, 54, and 72 months old than non-central symptoms. Bridging symptoms between negative and positive mental health were also assessed. RESULTS Though the depressive-anxiety network structures were stable during and after pregnancy, the post-partum network was more strongly connected. The central depressive-anxiety symptoms were also different between prenatal and post-partum networks. During pregnancy, central symptoms were mostly related to feeling worthless or useless; after pregnancy, central symptoms were mostly related to feeling overwhelmed or being punished. Central symptoms during pregnancy were associated with poorer developmental outcomes for the child. Anxiety symptoms were strongest bridging symptoms during and after pregnancy. The interactions between negative and positive mental health symptoms were also different during and after pregnancy. CONCLUSIONS The differences between pre- and post-partum networks suggest that the presentation of maternal mental health problems varies over the peripartum period. This variation is not captured by traditional symptom scale scores. The bridging symptoms also suggest that anxiety symptoms may precede the development of maternal depression. Interventions and public health policies should thus be tailored to specific pre- and post-partum symptom profiles.
Collapse
Affiliation(s)
- Desiree Y. Phua
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Helen Chen
- Department of Psychological Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Peter D. Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Centre for Human Evolution, Adaptation and Disease, Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Birit F. P. Broekman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Amsterdam UMC and OLVG, VU University, Amsterdam, Netherlands
| | - Michael J. Meaney
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Sackler Program for Epigenetics & Psychobiology, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| |
Collapse
|