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Silverio SA, George-Carey R, Memtsa M, Kent-Nye FE, Magee LA, Sheen KS, Burgess K, Oza M, Storey C, Sandall J, Easter A, von Dadelszen P, Jurković D. Preliminary findings on the experiences of care for women who suffered early pregnancy losses during the COVID-19 pandemic: a qualitative study. BMC Pregnancy Childbirth 2024; 24:522. [PMID: 39123186 PMCID: PMC11312198 DOI: 10.1186/s12884-024-06721-7] [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: 11/10/2023] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Women who suffer an early pregnancy loss require specific clinical care, aftercare, and ongoing support. In the UK, the clinical management of early pregnancy complications, including loss is provided mainly through specialist Early Pregnancy Assessment Units. The COVID-19 pandemic fundamentally changed the way in which maternity and gynaecological care was delivered, as health systems moved to rapidly reconfigure and re-organise services, aiming to reduce the risk and spread of SARS-CoV-2 infection. PUDDLES is an international collaboration investigating the pandemic's impact on care for people who suffered a perinatal bereavement. Presented here are initial qualitative findings undertaken with UK-based women who suffered early pregnancy losses during the pandemic, about how they navigated the healthcare system and its restrictions, and how they were supported. METHODS In-keeping with a qualitative research design, in-depth semi-structured interviews were undertaken with an opportunity sample of women (N = 32) who suffered any early pregnancy loss during the COVID-19 pandemic. Data were analysed using a template analysis to understand women's access to services, care, and networks of support, during the pandemic following their pregnancy loss. The thematic template was based on findings from parents who had suffered a late-miscarriage, stillbirth, or neonatal death in the UK, during the pandemic. RESULTS All women had experienced reconfigured maternity and early pregnancy services. Data supported themes of: 1) COVID-19 Restrictions as Impractical & Impersonal; 2) Alone, with Only Staff to Support Them; 3) Reduction in Service Provision Leading to Perceived Devaluation in Care; and 4) Seeking Their Own Support. Results suggest access to early pregnancy loss services was reduced and pandemic-related restrictions were often impractical (i.e., restrictions added to burden of accessing or receiving care). Women often reported being isolated and, concerningly, aspects of early pregnancy loss services were reported as sub-optimal. CONCLUSIONS These findings provide important insight for the recovery and rebuilding of health services in the post-pandemic period and help us prepare for providing a higher standard of care in the future and through any other health system shocks. Conclusions made can inform future policy and planning to ensure best possible support for women who experience early pregnancy loss.
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Affiliation(s)
- Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK.
| | | | - Maria Memtsa
- Gynaecology Service, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, Faculty of Population Health Sciences, School of Life and Medical Sciences, University College London, London, United Kingdom
| | - Flora E Kent-Nye
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Laura A Magee
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Kayleigh S Sheen
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Social Sciences, College of Health, Science & Society, University of the West of England Bristol, Bristol, UK
| | - Karen Burgess
- Petals: The Baby Loss Counselling Charity, Cambridge, UK
| | | | - Claire Storey
- Patient and Public Involvement and Engagement Group for Perinatal Bereavement, Trauma, & Loss, King's College London, London, UK
| | - Jane Sandall
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Abigail Easter
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Peter von Dadelszen
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Davor Jurković
- Gynaecology Diagnostic and Treatment Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, Faculty of Population Health Sciences, School of Life and Medical Sciences, University College London, London, United Kingdom
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Hu S, Su C, Zhou L, Dai L. Reliability and validity of the Chinese version of the COMPI Fertility Problem Stress Scale-Short Form for infertile women. Int J Gynaecol Obstet 2024; 165:1261-1267. [PMID: 38205844 DOI: 10.1002/ijgo.15342] [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: 04/10/2023] [Revised: 08/13/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To translate and culturally adapt the COMPI Fertility Problem Stress Scale-Short form (COMPI-FPSS-SF) and to test its reliability and validity in China. METHODS The cross-sectional study adopted Brislin's translation model to translate, synthesize, back-translate, and cross-culturally adapt the COMPI-FPSS-SF for the Chinese setting. A total of 279 infertile women were invited to participate in the study to test the reliability and validity of the scale between March and June 2021. RESULTS It was verified that the Chinese version of the COMPI-FPSS-SF has three domains with nine items. The Cronbach's α coefficient of the total scale was 0.907, and the coefficient for each dimension ranged from 0.760 to 0.855. The test-retest validity was 0.891. The exploratory factor analysis extracted three common factors with eigenvalues of 4.499, 1.124, and 1.011 and a cumulative variance contribution of 73.706. The validity factor analysis showed good results for the three-factor structure fit. The criterion-related validity with the Fertility Inventory Short-Form Scale was 0.649. The above analysis revealed statistically significant differences (P < 0.001). CONCLUSIONS The Chinese version of the COMPI-FPSS-SF can be used for the assessment of fertility-related stress in infertility patients in China with good reliability and validity.
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Affiliation(s)
- Shuang Hu
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, Chongqing, China
| | - Chengying Su
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, Chongqing, China
| | - Linlin Zhou
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, Chongqing, China
| | - Ling Dai
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, Chongqing, China
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Inversetti A, Perna G, Lalli G, Grande G, Di Simone N. Depression, Stress and Anxiety among Women and Men Affected by Recurrent Pregnancy Loss (RPL): A Systematic Review and Meta-Analysis. Life (Basel) 2023; 13:1268. [PMID: 37374051 DOI: 10.3390/life13061268] [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: 04/28/2023] [Revised: 05/21/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
The aim of the present study is to perform a systematic review and meta-analysis on depression, stress and anxiety in women who experienced recurrent pregnancy loss (RPL) compared to controls and to men who experienced RPL. The pooled results showed a higher level of moderate/severe depression among women who experienced RPL compared to controls (5359 women, random effects model, odds ratio (OR) 3.77, 95% Confidence Interval (CI) 2.71-5.23, p < 0.00001, I2 0%). Anxiety and stress levels were also higher among women experiencing RPL compared to controls. The pooled results showed a higher level of moderate/severe depression in women who experienced RPL compared to men who underwent the same experience (113/577 (19.5%) women versus 33/446 (7%) men versus random effects model, OR 4.63; 95% CI 2.95-7.25, p < 0.00001 I2 0%). Similarly, higher levels of stress and anxiety in women experiencing RPL compared to men experiencing RPL were described. Women who experienced RPL showed higher rates of moderate-severe depression, stress and anxiety compared to both controls and men who experienced RPL. Healthcare professionals should implement screening for anxiety and depression and social support for both partners and support them in dealing with RPL according to sex-specific responses to this stressful event.
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Affiliation(s)
- Annalisa Inversetti
- Humanitas University Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Giampaolo Perna
- Humanitas University Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Gloria Lalli
- Humanitas University Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Giuseppe Grande
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, 35128 Padua, Padua, Italy
| | - Nicoletta Di Simone
- Humanitas University Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
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Hung HM, Kuo PL, Lee CS, Chen CH. Effectiveness of mental health website intervention on stress and depression for women with recurrent miscarriage: A randomized controlled trial. Health Care Women Int 2023; 44:496-508. [PMID: 36856797 DOI: 10.1080/07399332.2022.2141744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We aimed to investigate the effect of a mental health website intervention on perceived stress, depression, sleep quality, and social support in women with recurrent miscarriage (RM). Performing a randomized controlled trial, the participants in the experimental group (n = 31) received a 12-week mental health website intervention; the participants in the control group (n = 31) received RM standard medical care only. The paired t-tests results for the mean posttest scores for depression (p = .023) and perceived stress (p = .041) in the experimental group showed a significant decrease, but did not in the control group.
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Affiliation(s)
- Hsuan-Man Hung
- Department of Nursing, Fooyin University, Kaohsiung, Taiwan
| | - Pao-Lin Kuo
- Department of Obstetrics and Gynecology, College of Medicine, National Cheng-Kung University, Tainan, Taiwan
| | - ChihChen Sophia Lee
- Director of Music Therapy, Southwestern Oklahoma State University, Weatherford, OK, USA
| | - Chung-Hey Chen
- Department of Nursing, Hungkuang University, Taichung, Taiwan.,Department of Nursing & Institute of Allied Health Sciences, National Cheng Kung University, Tainan, Taiwan
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Kuhlmann E, Scharli P, Schick M, Ditzen B, Langer L, Strowitzki T, Wischmann T, Kuon RJ. The Posttraumatic Impact of Recurrent Pregnancy Loss in Both Women and Men. Geburtshilfe Frauenheilkd 2023; 83:88-96. [PMID: 36643876 PMCID: PMC9835763 DOI: 10.1055/a-1916-9180] [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] [Received: 06/17/2022] [Accepted: 08/02/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Recurrent pregnancy loss is usually associated with significant psychological distress for both partners of the couple. It may act as a traumatic experience resulting in a posttraumatic stress disorder. The object of this study is to examine the posttraumatic impact of recurrent pregnancy loss on men and women and their interdependencies. Methods Cross-sectional study. All couples referred to the special unit for recurrent pregnancy loss between March 2019 and October 2020 were asked to participate with a sample size of 105 couples and 17 women. They were invited to complete a questionnaire package estimating the prevalence of posttraumatic stress, with anxiety, depression, lack of social support and dysfunctional coping strategies as contributing risk factors. Couple data were analysed with the Actor Partner Interdependence Model, taking the couple as a dyad. Results The response rate was 82.3 percent, with posttraumatic stress being measured in 13.7% of the women versus 3.9% of the men (p = 0.017). For women, number of curettages, controlled for the number of losses, correlated with the severity of posttraumatic stress (p < 0.05). Higher levels of anxiety, depression and lack of social support in women correlated positively with posttraumatic stress in their partners. The men's coping strategy "trivialization and wishful thinking" as well as "avoidance" correlated with more severe posttraumatic stress in the female partners (both p < 0.05). Conclusion The posttraumatic risks within a couple with recurrent pregnancy loss are interdependent. Recurrent pregnancy loss clinics should assess posttraumatic risks of both partners in their routine diagnostic process.
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Affiliation(s)
- Emily Kuhlmann
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany,Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany
| | - Pauline Scharli
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany,Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany
| | - Maren Schick
- Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany,Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany,Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Laila Langer
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany
| | - Thomas Strowitzki
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany
| | - Tewes Wischmann
- Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany
| | - Ruben-J. Kuon
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany,Korrespondenzadresse Prof. Dr. Ruben-J. Kuon Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s HospitalIm Neuenheimer Feld 44069120 HeidelbergGermany
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Nitu R, Neamtu R, Iordache O, Stelea L, Dahma G, Sacarin G, Socol G, Boarta A, Silaghi C, Puichita D, Diaconu MM. A Cross-Sectional Analysis of Intimacy Problems, Stress Levels, and Couple Satisfaction among Women with Thrombophilia Affected by Recurrent Pregnancy Loss. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1208. [PMID: 36673963 PMCID: PMC9859390 DOI: 10.3390/ijerph20021208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/06/2023] [Accepted: 01/08/2023] [Indexed: 06/17/2023]
Abstract
Recurrent pregnancy loss (RPL) is one of the most challenging and difficult areas of reproductive treatment due to the immense emotional suffering inflicted on families and couples affected by RPL. As a result, it is predicted that couples experiencing recurrent pregnancy loss would have an increase in marital problems, stress levels, and anxiety, preventing them from achieving their family goals. The current cross-sectional study aimed to target pregnant women with thrombophilia with a history of RPL to observe their intimacy problems, stress levels, and couple satisfaction by completing a series of digital questionnaires. These patients were considered as the reference group, while the control group was formed by other women with thrombophilia and a history of RPL who eventually achieved pregnancy and gave birth. A total of 238 complete questionnaires were recorded (157 in the reference group and 81 in the control group). It was observed that women in the reference group who did not give birth had a significantly higher proportion of three or more pregnancy attempts (54.1% vs. 39.5%) and a significantly higher proportion of three more pregnancy losses (68.8% vs. 55.6%). It was observed that patients in the reference group were more likely to be emotion-oriented (42.7% vs. 27.2%). Also, women in the reference group had higher levels of dissatisfaction and lower levels of self-acceptance, pleasure, and marital quality scores. The total SII and DSCS scores were significantly lower than women with thrombophilia with a history of RPL who eventually gave birth. Women from the reference group had significantly greater intimacy problems and stress levels while having lower openness scores and self-esteem scores than women in the control group. It is possible that women with thrombophilia and recurrent pregnancy loss are more dissatisfied with their marriages than those who subsequently had one child. Since the financial status of those who achieved pregnancy was observed to be higher, it is likely that they achieved pregnancy by ART interventions, as they reported in questionnaires. It is important to target families afflicted by thrombophilia and other reasons for infertility to ease their access to ART therapies. By achieving their objectives, affected families will minimize dissatisfaction, divorce rates, and stress.
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7
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Self-Reported Depression among Chinese Women with Recurrent Pregnancy Loss: Focusing on Associated Risk Factors. J Clin Med 2022; 11:jcm11247474. [PMID: 36556090 PMCID: PMC9785000 DOI: 10.3390/jcm11247474] [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] [Received: 11/18/2022] [Revised: 11/30/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
(1) Background: To investigate whether women suffering from recurrent pregnancy loss (RPL) have a higher prevalence of self-reported depression than healthy controls and to assess the associated risk factors for RPL women self-reporting the symptom of depression. (2) Methods: A cross-sectional study investigating 247 women with histories of RPL and 193 healthy women was performed in Southwest China. The Zung Self-Rating Depression Scale (SDS) was used to measure self-reported depression, and the prevalence of self-reported depression was compared between the two groups. Sociodemographic data for the two groups and clinical information for the RPL group were collected by questionnaires. (3) Results: The prevalence of self-reported depression was higher in the RPL group than in the control group (45.3% vs. 30.1%, p < 0.01). Subgroup analyses indicated that the statistical difference in the prevalence of self-reported depression was significant in the subgroups of women in the first trimester of gestation, age ≥ 36 years, BMI ≥ 18.5 kg/m2, working hours ≤ 8 h/day, university and higher education, and urban residence. Multivariable logistic analysis indicated that age ≥ 36 years, >2 times of spontaneous miscarriages, and no history of live birth were independent risk factors for RPL women self-reporting depression. (4) Conclusions: A higher prevalence of self-reported depression was observed in RPL patients than in healthy women. The psychological status for RPL patients with age ≥ 36 years, >2 times of spontaneous miscarriages, or without a history of a live birth needs to be further addressed.
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Wu J, Lin S, Huang P, Qiu L, Jiang Y, Zhang Y, Meng N, Meng M, Wang L, Deng W, Liu Z, Guo C, Lu J, Wang H, Kong S. Maternal anxiety affects embryo implantation via impairing adrenergic receptor signaling in decidual cells. Commun Biol 2022; 5:840. [PMID: 35982177 PMCID: PMC9388523 DOI: 10.1038/s42003-022-03694-1] [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: 10/23/2021] [Accepted: 07/10/2022] [Indexed: 11/09/2022] Open
Abstract
Recurrent implantation failure (RIF) is defined as the failed pregnancy after good embryo transfer over 3 cycles during in vitro fertilization (IVF).The human endometrium plays a vital role in providing the site for embryo implantation, with several factors implicated in unsatisfactory endometrial receptivity in RIF. Our present results revealed that women with pregnancy loss or infertility have a higher serum epinephrine level, indicating a potential correlation between psychological stress and pregnancy failure. RNA-sequencing of the tissues collected at the endometrial receptive phase in normal and RIF women showed that stress hormones could affect the functional status of endometrial receptivity. Subsequent analysis revealed that the epinephrine signaling acts as an important regulator of endometrial receptivity through the PI3K-AKT and FOXO1 signaling pathways. We also found that patients with RIF show attenuated expression of the alpha-2C-adrenergic receptor (ADRA2C) and that its down regulation induced by high level epinephrine could inhibit the decidualization. Early pregnant mice treated with stress showed high serum epinephrine levels, defective uterine adrenergic receptor expression, and low pregnancy rates. Altogether, our findings indicate that mental stress during early pregnancy can alter the functional status of endometrial receptivity.
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Affiliation(s)
- Jinxiang Wu
- Department of Reproductive Medicine, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China.
| | - Shu Lin
- Centre of Neurological and Metabolic Research, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China.,Diabetes and Metabolism Division, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney, NSW, 2010, Australia
| | - Pinxiu Huang
- Fujian Provincial Key Laboratory of Reproductive Health Research, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Lingling Qiu
- Department of Reproductive Medicine, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Yufei Jiang
- Fujian Provincial Key Laboratory of Reproductive Health Research, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Ying Zhang
- Fujian Provincial Key Laboratory of Reproductive Health Research, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Nan Meng
- Fujian Provincial Key Laboratory of Reproductive Health Research, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Meiqing Meng
- Fujian Provincial Key Laboratory of Reproductive Health Research, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Lemeng Wang
- Fujian Provincial Key Laboratory of Reproductive Health Research, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Wenbo Deng
- Fujian Provincial Key Laboratory of Reproductive Health Research, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Zhao Liu
- Fujian Provincial Key Laboratory of Reproductive Health Research, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Chuanhui Guo
- Fujian Provincial Key Laboratory of Reproductive Health Research, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Jinhua Lu
- Fujian Provincial Key Laboratory of Reproductive Health Research, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Haibin Wang
- Fujian Provincial Key Laboratory of Reproductive Health Research, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.
| | - Shuangbo Kong
- Fujian Provincial Key Laboratory of Reproductive Health Research, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.
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Jansen C, Kuhlmann E, Scharli P, Schick M, Ditzen B, Langer L, Strowitzki T, Kuon RJ, Wischmann T. “A sorrow shared …”: a qualitative content analysis of what couples with recurrent miscarriages expect from one another and their families and friends. Hum Reprod Open 2022; 2022:hoac032. [PMID: 35928048 PMCID: PMC9345061 DOI: 10.1093/hropen/hoac032] [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: 09/07/2021] [Revised: 07/05/2022] [Indexed: 12/04/2022] Open
Abstract
STUDY QUESTION When couples have to face recurrent pregnancy loss (RPL), what are the partners’ wishes and needs and what is their perception of helpful and unhelpful factors with regard to their own, their partners’ and their families’ and friends’ ways of dealing with the problem? SUMMARY ANSWER Women and men with repeated miscarriages want open communication about their losses, but expect a sensitive and empathetic attitude from others, not pity or trivialization. WHAT IS KNOWN ALREADY RPL not only causes the women affected and their partners considerable emotional distress; it also has an impact on the couples’ relationships and the way they relate to their families and friends. Studies suggest that women have a greater need than their male partners to talk about their losses and that these differences may lead to dissatisfaction and cause relational tension. In addition, men often assume a ‘mainstay’ role, supporting their partners and displaying fortitude in the face of distress. As yet, however, little research has been conducted so far on the question of what the members of couples with RPL expect from one another and from their families and friends. STUDY DESIGN, SIZE, DURATION The study sample consisted of 147 couples and 17 women with at least 2 miscarriages attending the special unit for RPL at the University Women’s Hospital in Heidelberg (Germany) for the first time between September 2018 and October 2020 (response rate: 82.7%). The patients were asked to participate in this combined qualitative and questionnaire study. PARTICIPANTS/MATERIALS, SETTING, METHODS In order to explore the wishes and needs of those affected in more detail, the free text responses obtained were examined in this study by using qualitative content analysis. Categories and subcategories were created inductively to summarize and systematize content. MAIN RESULTS AND THE ROLE OF CHANCE Patients affected by RPL want their partners and their families and friends to deal with the topic openly and empathically. In the partnership itself, acceptance of individual grieving modes and sharing a common goal are important factors. Men, in particular, want their partners to be optimistic in facing up to the situation. Regarding communication with family and friends, it transpired that ‘good advice’, playing the matter down, inquiries about family planning, pity and special treatment are explicitly not appreciated. LIMITATIONS, REASONS FOR CAUTION The sample was a convenience sample, so self-selection effects cannot be excluded. In addition, the level of education in the sample was above average. Accordingly, the sample cannot be regarded as representative. The results of the content analysis are based on the respondents’ written answers to open-ended questions in the questionnaire. Unlike qualitative interview studies, further questioning was not possible in the case of ambiguities or to request more details. WIDER IMPLICATIONS OF THE FINDINGS Frank and sincere communication about miscarriages and about one’s own emotions and needs should be promoted both in the partnership and among family members and friends in order to strengthen the potential of social support as a resource. Open communication about the different needs of both partners is necessary to create mutual understanding. The results show the importance not only of empathy and consideration for the couples concerned but also their desire not to be pitied. Striking a fine balance between fellow-feeling and pity may also lead to tension, and this potential dilemma should be addressed in psychosocial counselling. Overall, the study contributes to a better understanding of what couples want from their families and friends when they are attempting to come to terms with RPL and highlights potential challenges in the interaction between affected couples and their families and friends. STUDY FUNDING/COMPETING INTEREST(S) No funding was received for this study. None of the authors declared any conflicts of interest. TRIAL REGISTRATION NUMBER DRKS00014965.
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Affiliation(s)
- C Jansen
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital Heidelberg , Germany
| | - E Kuhlmann
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital Heidelberg , Germany
- Heidelberg University Women’s Hospital Department of Gynaecological Endocrinology and Fertility Disorders, , Germany
| | - P Scharli
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital Heidelberg , Germany
- Heidelberg University Women’s Hospital Department of Gynaecological Endocrinology and Fertility Disorders, , Germany
| | - M Schick
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital Heidelberg , Germany
- University of Heidelberg , Heidelberg, Germany
| | - B Ditzen
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital Heidelberg , Germany
- University of Heidelberg , Heidelberg, Germany
| | - L Langer
- Heidelberg University Women’s Hospital Department of Gynaecological Endocrinology and Fertility Disorders, , Germany
| | - T Strowitzki
- Heidelberg University Women’s Hospital Department of Gynaecological Endocrinology and Fertility Disorders, , Germany
| | - R -J Kuon
- Heidelberg University Women’s Hospital Department of Gynaecological Endocrinology and Fertility Disorders, , Germany
| | - T Wischmann
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital Heidelberg , Germany
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10
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Vescovi G, Corrêa MA, Frizzo GB, Dias ACG, Levandowski DC. Construction of Meaning in Pregnancy Loss: Qualitative Study with Brazilian Couples. PSICO-USF 2022. [DOI: 10.1590/1413-82712022270301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract We investigated the process of meaning construction in pregnancy loss in 11 Brazilian couples. The reports were submitted to inductive and deductive thematic analysis using the categorization system from the integrative model of meaning construction in grief. Regarding the original dimensions of the model (Sense-making of death, benefit from the experience of loss, and identity change), there was a lack of meaning for death, perception of strengthened bonds within the couple as a benefit, and parenting as an identity project. We propose an additional dimension (Meaning-making process) that includes gender differences, lack of social recognition, and emotional intensity of the experience. As for coping strategies, spirituality and the search for peers were identified, especially in social media. After a pregnancy loss, the process of meaning construction proved similar to that of other types of loss, validating this experience. We discuss the implications of the category system used in this study.
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11
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Dollberg DG, Harlev Y, Malishkevitch S, Leitner Y. Parental Reflective Functioning as a Moderator of the Link Between Prematurity and Parental Stress. Front Psychiatry 2022; 13:804694. [PMID: 35280157 PMCID: PMC8905191 DOI: 10.3389/fpsyt.2022.804694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
We examined group differences between parents, both mothers and fathers, of premature and full-term infants to determine whether they differed in their reports of subjective parenting stress and in their level of parental reflective functioning (PRF). We also tested whether each parent's reflective functioning moderated the links between birth status (prematurity vs. full-term) and parenting stress. A sample of 73 cohabiting, heterosexual Israeli families with a premature (28-36th week gestational age, N = 34) or full-term infant (37th week and above gestational age, N = 39) participated, comprising the two parents' groups. Infants' age averaged 7.07 months (SD = 1.28). Each parent completed the Parent Stress Inventory (PSI) individually to determine his/her subjective personal and childrearing stress levels. The Parent Development Interview (PDI-R2-S) was used to obtain each parent's PRF (self and child/relation-focused) level. Findings showed that the premature and full-term parents did not differ in their PSI scores or PRF levels. However, mothers' self-focused PRF moderated the link between prematurity and personal parenting stress, whereas fathers' self-focused PRF moderated the link between prematurity and childrearing parenting stress. Furthermore, fathers' and mothers' PRF operated differently in the premature and full-term parents' groups. The findings highlight the importance of mothers' and fathers' PRF in predicting parents' subjective stress in general and particularly in the case of infant prematurity. We discuss these findings and their relevance for preventive and therapeutic perinatal interventions.
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Affiliation(s)
- Daphna G Dollberg
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Yael Harlev
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Sivan Malishkevitch
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Yael Leitner
- Child Development Center, Dana-Dwek Children's Hospital, Sourasky Medical Center, Tel Aviv, Israel
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12
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du Fossé NA, Lashley EELO, Treurniet TT, van Lith JMM, le Cessie S, Boosman H, van der Hoorn MLP. Exploring gender differences among couples with unexplained recurrent pregnancy loss regarding preferences for supportive care. BMC Pregnancy Childbirth 2021; 21:796. [PMID: 34847864 PMCID: PMC8630871 DOI: 10.1186/s12884-021-04277-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 11/16/2021] [Indexed: 12/01/2022] Open
Abstract
Background International guidelines recommend to offer supportive care during a next pregnancy to couples affected by recurrent pregnancy loss (RPL). In previous research, several options for supportive care have been identified and women’s preferences have been quantified. Although it is known that RPL impacts the mental health of both partners, male preferences for supportive care have hardly been explored. Methods A cross-sectional study was conducted in couples who visited a specialized RPL clinic in the Netherlands between November 2018 and December 2019. Both members of the couples received a questionnaire that quantified their preferences for supportive care in a next pregnancy and they were asked to complete this independently from each other. Preferences for each supportive care option were analysed on a group level (by gender) and on a couple level, by comparing preferences of both partners. Results Ninety-two questionnaires (completed by 46 couples) were analysed. The overall need for supportive care indicated on a scale from 1 to 10 was 6.8 for men and 7.9 for women (P = 0.002). Both genders preferred to regularly see the same doctor with knowledge of their obstetric history, to make a plan for the first trimester and to have frequent ultrasound examinations. A lower proportion of men preferred a doctor that shows understanding (80% of men vs. 100% of women, P = 0.004) and a doctor that informs on wellbeing (72% vs. 100%, P = ≤0.000). Fewer men preferred support from friends (48% vs. 74%, P = 0.017). Thirty-seven percent of men requested more involvement of the male partner at the outpatient clinic, compared to 70% of women (P = 0.007). In 28% of couples, partners had opposing preferences regarding peer support. Conclusions While both women and men affected by RPL are in need of supportive care, their preferences may differ. Current supportive care services may not entirely address the needs of men. Health care professionals should focus on both partners and development of novel supportive care programs with specific attention for men should be considered. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04277-4.
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Affiliation(s)
- N A du Fossé
- Department of Gynecology and Obstetrics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands. .,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, 2333 ZA, the Netherlands.
| | - E E L O Lashley
- Department of Gynecology and Obstetrics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
| | - T T Treurniet
- Department of Gynecology and Obstetrics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
| | - J M M van Lith
- Department of Gynecology and Obstetrics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
| | - S le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, 2333 ZA, the Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, 2333 ZA, the Netherlands
| | - H Boosman
- Department of Quality and Patient Safety, Leiden University Medical Center, Leiden, 2333 ZA, the Netherlands
| | - M L P van der Hoorn
- Department of Gynecology and Obstetrics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
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13
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Jensen KHK, Krog MC, Koert E, Hedegaard S, Chonovitsch M, Schmidt L, Kolte AM, Nielsen HS. Meditation and mindfulness reduce perceived stress in women with recurrent pregnancy loss: a randomized controlled trial. Reprod Biomed Online 2021; 43:246-256. [PMID: 34112605 DOI: 10.1016/j.rbmo.2021.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 11/19/2022]
Abstract
RESEARCH QUESTION Can participating in a tailored 7-week meditation and mindfulness programme with additional standard supportive care versus standard supportive care only reduce perceived stress for women with recurrent pregnancy loss (RPL)? DESIGN A two-armed randomized controlled trial (RCT) with 12-month follow-up. In total 76 patients were enrolled and randomly assigned to either standard supportive care or to a 7-week meditation and mindfulness programme led by an instructor in addition to standard supportive care. RESULTS At intervention completion (after 7 weeks), perceived stress decreased significantly both in the intervention group (P = 0.001) and in the control group (P = 0.006). The decrease in perceived stress in the intervention group was significantly larger (P = 0.027) compared with the control group. At the 12-month follow-up perceived stress was still significantly decreased in both groups compared with baseline (P < 0.0001 in the intervention group and P = 0.002 in the control group). CONCLUSION This first RCT of a tailored meditation and mindfulness intervention for women with RPL documents that a 7-week daily at-home meditation and mindfulness programme combined with group sessions reduced perceived stress significantly more than a standard supportive care programme. Future studies should address the most effective format and the 'dose' needed for an impact on perceived stress levels.
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Affiliation(s)
- Karen Henriette Kirchheiner Jensen
- Recurrent Pregnancy Loss Unit, Copenhagen University Hospitals, Rigshospitalet, Fertility Clinic 4071, Copenhagen Ø, Denmark and Hvidovre Hospital, Department of Obstetrics and Gynaecology, Hvidovre, Denmark.
| | - Maria Christine Krog
- Recurrent Pregnancy Loss Unit, Copenhagen University Hospitals, Rigshospitalet, Fertility Clinic 4071, Copenhagen Ø, Denmark and Hvidovre Hospital, Department of Obstetrics and Gynaecology, Hvidovre, Denmark; Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen Ø, Denmark
| | - Emily Koert
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen Ø, Denmark
| | - Signe Hedegaard
- Recurrent Pregnancy Loss Unit, Copenhagen University Hospitals, Rigshospitalet, Fertility Clinic 4071, Copenhagen Ø, Denmark and Hvidovre Hospital, Department of Obstetrics and Gynaecology, Hvidovre, Denmark
| | - Marie Chonovitsch
- Recurrent Pregnancy Loss Unit, Copenhagen University Hospitals, Rigshospitalet, Fertility Clinic 4071, Copenhagen Ø, Denmark and Hvidovre Hospital, Department of Obstetrics and Gynaecology, Hvidovre, Denmark
| | - Lone Schmidt
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen Ø, Denmark
| | - Astrid Marie Kolte
- Recurrent Pregnancy Loss Unit, Copenhagen University Hospitals, Rigshospitalet, Fertility Clinic 4071, Copenhagen Ø, Denmark and Hvidovre Hospital, Department of Obstetrics and Gynaecology, Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Henriette Svarre Nielsen
- Recurrent Pregnancy Loss Unit, Copenhagen University Hospitals, Rigshospitalet, Fertility Clinic 4071, Copenhagen Ø, Denmark and Hvidovre Hospital, Department of Obstetrics and Gynaecology, Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
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14
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Aksoy D, Egelioğlu Cetişli N. Recurrent pregnency loss: Depression, hopelessness, and martial adjustment. Perspect Psychiatr Care 2021; 57:821-826. [PMID: 32936952 DOI: 10.1111/ppc.12620] [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: 05/02/2020] [Revised: 08/21/2020] [Accepted: 09/05/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of the study was to determine depression, hopelessness level and marital adjustment of women diagnosed with recurrent pregnancy loss (RPL). DESIGN AND METHOD This descriptive study included 66 RPL women. FINDINGS It was found that hopelessness level of 47% of women was mild, 18.2% of them were moderate, and 13.6% of them were severe. Depression level of women 30.3% were moderate, 24.3% of them were mild, and 1.5% of them were severe. It was found that women's marital adjustment was low, and their level of depression increased with increasing hopelessness. PRACTICE IMPLICATIONS It was found in the study that evaluating women, who are diagnosed with RPL, regarding their marriage problems, hopelessness, and depression level together with their partners is important.
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Affiliation(s)
- Duygu Aksoy
- Department of Gynecology and Obstetrics, University of Health Sciences Izmir Bozyaka Research and Training Hospital, İzmir, Turkey
| | - Nuray Egelioğlu Cetişli
- Department of Gynecology and Obstetrics, Faculty of Health Sciences, İzmir Katip Celebi University, İzmir, Turkey
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15
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Hedegaard S, Landersoe SK, Olsen LR, Krog MC, Kolte AM, Nielsen HS. Stress and depression among women and men who have experienced recurrent pregnancy loss: focusing on both sexes. Reprod Biomed Online 2021; 42:1172-1180. [PMID: 33962908 DOI: 10.1016/j.rbmo.2021.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/04/2021] [Accepted: 03/15/2021] [Indexed: 02/06/2023]
Abstract
RESEARCH QUESTION Are women and men suffering from recurrent pregnancy loss (RPL) more affected by psychological stress and depression than the general population? DESIGN Cross-sectional study investigating the prevalence of stress and depression in women and men with RPL seen in the Danish national RPL Unit. Data were collected between 2015-2018. All newly referred couples were asked to complete the Major Depression Index (MDI) and Cohen's Perceived Stress Scale (PSS). The scores of both sexes were compared with scores from relevant cohorts of men and women from the general population. RESULTS In total, 412 women with RPL (82% response rate) and 281 male partners (60% response rate) were included. Depression: 5/281 (1.8%) of men with RPL had moderate/severe depression vs. 5/253 (2.0%) of men in the comparison group (relative risk (RR) 0.90; 95% CI 0.26-3.07, p=0.99). Among women with RPL, 34/412 (8.3%) had a moderate/severe depression vs. 2.2% in the comparison group (RR 3.74; 95% CI 2.40-5.83, p<0.001). High stress levels were found in 30/281 men with RPL (10.7%) vs. 15.8% in the comparison group (co-habiting men) (RR 0.67; 95% CI 0.48-0.94, p=0.017). High stress level was found among 110/384 (28.6%) of RPL-women vs. 420/1813 (23.2%) of comparison women (RR 1.24; 95% CI 1.03-1.48, p=0.026). Both MDI and PSS scores, respectively, for a woman and a man in an RPL couple were significantly correlated. CONCLUSION Male partners in RPL couples did not have increased prevalence of stress and depression compared with other men but we confirmed our previous finding of significantly increased frequencies among women with RPL.
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Affiliation(s)
- Signe Hedegaard
- Recurrent Pregnancy Loss Unit, Capital Region, Copenhagen University Hospitals, Hvidovre Hospital, Dept. of Obstetrica and Gynecology, Kettegård Allé 30, DK-2650 Hvidovre, Denmark and Rigshospitalet, Fertility Clinic 4071, Blegdamsvej 9, Copenhagen Ø DK-2100, Denmark.
| | - Selma Kloeve Landersoe
- Recurrent Pregnancy Loss Unit, Capital Region, Copenhagen University Hospitals, Hvidovre Hospital, Dept. of Obstetrica and Gynecology, Kettegård Allé 30, DK-2650 Hvidovre, Denmark and Rigshospitalet, Fertility Clinic 4071, Blegdamsvej 9, Copenhagen Ø DK-2100, Denmark
| | - Lis Raabaek Olsen
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Maria Christine Krog
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9 DK-2100, Denmark
| | - Astrid Marie Kolte
- Recurrent Pregnancy Loss Unit, Capital Region, Copenhagen University Hospitals, Hvidovre Hospital, Dept. of Obstetrica and Gynecology, Kettegård Allé 30, DK-2650 Hvidovre, Denmark and Rigshospitalet, Fertility Clinic 4071, Blegdamsvej 9, Copenhagen Ø DK-2100, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Henriette Svarre Nielsen
- Recurrent Pregnancy Loss Unit, Capital Region, Copenhagen University Hospitals, Hvidovre Hospital, Dept. of Obstetrica and Gynecology, Kettegård Allé 30, DK-2650 Hvidovre, Denmark and Rigshospitalet, Fertility Clinic 4071, Blegdamsvej 9, Copenhagen Ø DK-2100, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark
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Wang Y, Meng Z, Pei J, Qian L, Mao B, Li Y, Li J, Dai Z, Cao J, Zhang C, Chen L, Jin Y, Yi B. Anxiety and depression are risk factors for recurrent pregnancy loss: a nested case-control study. Health Qual Life Outcomes 2021; 19:78. [PMID: 33685488 PMCID: PMC7938475 DOI: 10.1186/s12955-021-01703-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the interaction of depression and anxiety with the development of recurrent pregnancy loss (RPL). METHODS A nested case-control study involving 2558 participants was conducted with data from the prospective Miscarriage Woman Cohort study between 2017 and 2019 in the province of Gansu, China. The questionnaire data, self-rating anxiety scale and self-rating depression scale were collected after each participant's first miscarriage. Information on RPL outcomes was obtained from the medical records within the subsequent 2 years. All patients diagosed RPL were recruited as cases whilst a randomly selected group of women with only one miscarriage in the past were recruited as controls. The logistic regression and the interaction effects between anxiety and depression and RPL were analysed. RESULTS The prevalence of anxiety (n = 325, 28.7% vs. n = 278, 19.5%) and depression symptoms (n = 550, 48.6% vs. n = 589, 41.3%) for the 1132 RPL cases were higher than 1426 non-RPL controls (P < 0.001). After adjusting for possible confounding variables, the odds ratio (OR) value, reflecting the multiplicative interaction, was 1.91 (95% CI 1.50-2.44, P < 0.001) for cases with both anxiety and depression symptoms compared with the non-RPL group. The relative excess risk of interaction value, reflecting the additive interaction between anxiety and depression to RPL was 1.15 (95% CI 0.32-4.21). Moreover, the adjusted OR for RPL cases with mild anxiety and severe depression was 2.77 (95% CI 1.07-44.14, P < 0.001), for RPL cases with severe anxiety and mild depression was 4.23 (95% CI 1.01-22.21, P < 0.001), for RPL cases with severe anxiety and moderate depression was 4.34 (95% CI 1.03-21.28, P < 0.001) and for RPL cases with severe anxiety and severe depression was 5.95 (95% CI 1.09-45.09, P < 0.05). CONCLUSIONS Either depression or anxiety alone could increase the risk of subsequent RPL. Anxiety and depression had a synergistic effect after the first miscarriage which increased the development of subsequent RPL disease.
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Affiliation(s)
- Yanxia Wang
- Department of Scientific Research Center of Gansu Provincial Maternity and Child-Care Hospital, No.143. Qilihe North Rd., Lanzhou, 730050, Gansu, People's Republic of China.
| | - Zhaoyan Meng
- Department of Perinatal Medicine Center of Gansu Provincial Maternity and Child-Care Hospital, No.143. Qilihe North Rd., Lanzhou, 730050, Gansu, People's Republic of China
| | - Jianyin Pei
- Department of Scientific Research Center of Gansu Provincial Maternity and Child-Care Hospital, No.143. Qilihe North Rd., Lanzhou, 730050, Gansu, People's Republic of China
| | - Liu Qian
- Department of Scientific Research Center of Gansu Provincial Maternity and Child-Care Hospital, No.143. Qilihe North Rd., Lanzhou, 730050, Gansu, People's Republic of China
| | - Baohong Mao
- Department of Scientific Research Center of Gansu Provincial Maternity and Child-Care Hospital, No.143. Qilihe North Rd., Lanzhou, 730050, Gansu, People's Republic of China
| | - Yamei Li
- Department of Scientific Research Center of Gansu Provincial Maternity and Child-Care Hospital, No.143. Qilihe North Rd., Lanzhou, 730050, Gansu, People's Republic of China
| | - Jing Li
- Department of Scientific Research Center of Gansu Provincial Maternity and Child-Care Hospital, No.143. Qilihe North Rd., Lanzhou, 730050, Gansu, People's Republic of China
| | - Zhirong Dai
- Department of Scientific Research Center of Gansu Provincial Maternity and Child-Care Hospital, No.143. Qilihe North Rd., Lanzhou, 730050, Gansu, People's Republic of China
| | - Jianing Cao
- Department of Scientific Research Center of Gansu Provincial Maternity and Child-Care Hospital, No.143. Qilihe North Rd., Lanzhou, 730050, Gansu, People's Republic of China
| | - Chunhua Zhang
- Department of Scientific Research Center of Gansu Provincial Maternity and Child-Care Hospital, No.143. Qilihe North Rd., Lanzhou, 730050, Gansu, People's Republic of China
| | - Lina Chen
- Department of Scientific Research Center of Gansu Provincial Maternity and Child-Care Hospital, No.143. Qilihe North Rd., Lanzhou, 730050, Gansu, People's Republic of China
| | - Yuxia Jin
- Department of Scientific Research Center of Gansu Provincial Maternity and Child-Care Hospital, No.143. Qilihe North Rd., Lanzhou, 730050, Gansu, People's Republic of China
| | - Bin Yi
- Department of Scientific Research Center of Gansu Provincial Maternity and Child-Care Hospital, No.143. Qilihe North Rd., Lanzhou, 730050, Gansu, People's Republic of China.
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Depression among Infertile Women in Gaza Strip: Symptom Severity and Predictors. DEPRESSION RESEARCH AND TREATMENT 2021; 2021:6616489. [PMID: 33564475 PMCID: PMC7867462 DOI: 10.1155/2021/6616489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/10/2021] [Accepted: 01/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mental disorders are expected for women suffering from infertility. Depression is a predictable consequence but requires more investigations and considerations. This study is aimed at determining the severity of depression symptoms and its predictors among infertile women in the Gaza Strip, Palestine. MATERIALS AND METHODS A cross-sectional study was conducted. Three hundred eighty-five infertile women participated and were selected by convenience sampling. The participated women were selected from three large and major in vitro fertilization treatment centers (Al Helo, Al Basma, and Hindawi). A validated Arabic version of the Beck Depression Inventory-II was used. Univariate and multivariate logistic regression was applied to determine potential predictors for depression symptoms, and p ≤ .05 was statistically significant. RESULTS The mean age of participated women was 29 ± 6.58 years, and the mean duration of marriage and infertility was 7.76 ± 5.31 and 5.43 ± 3.50 years, respectively. Half of the women had some form of depression symptoms (22.3%, 8.6%, and 10.6% showed to have mild depression, moderate, and severe depression symptoms, respectively). Predictors of depression symptoms were as follows: duration of marriage (Wald test: 10.493; CI95%: 0.248-0.774), at least one abortion (Wald test: 21.233; CI95%: 1.863-4.528), primary infertility (Wald test: 6.666; CI95%: 1.148-2.742), and husband cause of infertility (Wald test: 10.878; CI95%: 0.800-0.982). CONCLUSION Infertility affects the various aspect of women's life. Psychological intervention including counselling, support, and therapy would be necessary to limit the consequences of infertility. Such interventions could be implemented in infertility treatment clinics.
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Azin SA, Golbabaei F, Warmelink JC, Eghtedari S, Haghani S, Ranjbar F. Association of depression with sexual function in women with history of recurrent pregnancy Loss: descriptive-correlational study in Tehran, Iran. FERTILITY RESEARCH AND PRACTICE 2020; 6:21. [PMID: 33372644 PMCID: PMC7722297 DOI: 10.1186/s40738-020-00089-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 11/09/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE The present study aimed to investigate the relationship between depression and sexual function in women with recurrent pregnancy loss. METHODS In a cross-sectional correlational study, 130 consecutive patients with history of recurrent pregnancy loss were included who referred to Avicenna Fertility Center in Tehran, Iran during November 2018-February 2019. The outcomes were sexual dysfunction (Assessed with the Female Sexual Function Index) and depression (Evaluated with the Beck's Depression Inventory). The study data were analyzed by using Mann-Whitney and Kruskal-Wallis tests. RESULTS The study findings revealed that 40.8% of the participants suffered from some degrees of depression. The data analysis revealed that depression had a significant inverse correlation with sexual function and its domains (r = - 0.392, p < 0.001, R2= 0.15). The spouse' education level and economic status demonstrated a significant relationship with women's sexual function (p = 0.01, p = 0.033). A significant relationship was also detected between women's depression and economic status (p = 0.028). CONCLUSIONS The study findings showed that women with RPL who had severe depression indicated lower score of sexual function. Since psychological and sexual problems are not reported to health care providers due to giving priority to fertility issues or considering such issues as taboos, the assessment of sexual and mental health needs to be part of the consultation in women with history of RPL, whether the patient seeks help for depression and sexual dysfunction or not.
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Affiliation(s)
- Seyed Ali Azin
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Fahimeh Golbabaei
- Nursing Care Research Centre, School of Nursing and Midwifery, Iran University of Medical Sciences, Rashid Yasemi St., Valiasr Ave, Tehran, Iran
| | - J Catja Warmelink
- Department of Midwifery Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Department of General Practice & Elderly Medicine, University Medical Centre Groningen, University of Groningen, Amsterdam, The Netherlands.,AVAG (Amsterdam/Groningen Midwifery Academy), Amsterdam, The Netherlands
| | - Sadaf Eghtedari
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Shima Haghani
- Nursing Care Research Centre, School of Nursing and Midwifery, Iran University of Medical Sciences, Rashid Yasemi St., Valiasr Ave, Tehran, Iran
| | - Fahimeh Ranjbar
- Nursing Care Research Centre, School of Nursing and Midwifery, Iran University of Medical Sciences, Rashid Yasemi St., Valiasr Ave, Tehran, Iran.
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Voss P, Schick M, Langer L, Ainsworth A, Ditzen B, Strowitzki T, Wischmann T, Kuon RJ. Recurrent pregnancy loss: a shared stressor---couple-orientated psychological research findings. Fertil Steril 2020; 114:1288-1296. [PMID: 33039130 DOI: 10.1016/j.fertnstert.2020.08.1421] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare the psychological impact of recurrent pregnancy loss (RPL) on affected men and women and to determine risk and protective factors in both partners. DESIGN Cross-sectional study. SETTING University-affiliated fertility center. PATIENT(S) Ninety female/male couples and 14 women. INTERVENTION(S) Participants completed a questionnaire covering psychological risk factors (ScreenIVF), experience of pregnancy losses, coping strategies, and partnership satisfaction. MAIN OUTCOME MEASURE(S) Comparison of psychological risk factors, perception of RPL, and coping strategies between both partners and analysis of the influence of risk and protective factors. RESULT(S) In the ScreenIVF, 47.7% of women versus 19.1% of men showed a risk for anxiety, 51.7% versus 19.1% a risk for depression, and 28.1% versus 30.7% a risk for limited social support. The use of avoiding coping styles seems to be less favorable with regard to the psychological risk than active strategies. Having a child together and a satisfying partnership correlated with a lower risk for depression. Sharing the experience of RPL with others and being in a satisfying relationship correlated with a higher social support. CONCLUSION(S) Both men and women affected by RPL show high risks for developing depression and anxiety, underlining the importance of also including the male partners. The factors of communication with others, a satisfying relationship, and already having a child together correlate with decreased psychological risks. We advocate for health care professionals to implement screening for anxiety, depression, and social support for both partners and support them in dealing with RPL. REGISTRATION NUMBER The study is registered in the German Clinical Trials Register (DRKS), number DRKS00014965.
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Affiliation(s)
- Pauline Voss
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Heidelberg, Germany; Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Maren Schick
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany; Ruprecht-Karls Heidelberg University, Heidelberg, Germany
| | - Laila Langer
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Heidelberg, Germany
| | - Asrin Ainsworth
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany; Ruprecht-Karls Heidelberg University, Heidelberg, Germany
| | - Thomas Strowitzki
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Heidelberg, Germany
| | - Tewes Wischmann
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Ruben J Kuon
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Heidelberg, Germany.
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Williams HM, Jones LL, Coomarasamy A, Topping AE. Men living through multiple miscarriages: protocol for a qualitative exploration of experiences and support requirements. BMJ Open 2020; 10:e035967. [PMID: 32414830 PMCID: PMC7232625 DOI: 10.1136/bmjopen-2019-035967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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
INTRODUCTION Up to 1 in 4 pregnancies and 1 in 20 subsequent pregnancies end in miscarriage. Despite such prevalence the psychosocial effects are often unrecognised and unsupported. In the absence of any biomedical sequelae among men such marginalisation may be intensified. Men living through multiple miscarriages may also find any grief or anxiety intensified by loss of hope for future parenthood, but robust qualitative studies of these experiences are limited. We aim to rectify the deficiency. METHODS AND ANALYSIS Our qualitative study will adopt the sounds of silence framework designed by Serrant-Green to hear the voices of populations possibly marginalised. We will listen and learn from 30 to 50 men with a history of two or more miscarriages. The research participants will be recruited from a recurrent miscarriage clinic at a large tertiary hospital in England, and from advertisements to be disseminated by the project sponsor and miscarriage charities.Individual telephone interviews supported by a semistructured discussion guide will be audio-recorded, transcribed and anonymised. The transcriptions and any field notes will be interpreted by the framework method of Ritchie and Lewis embedded within the sounds of silence framework. Tentative findings will be presented to research participants in face-to-face focus group discussion, to enable member synthesis to enhance authenticity. The focus group discussion will be audio-recorded, transcribed, anonymised and similarly interpreted to contribute to our final synthesis. ETHICS AND DISSEMINATION The protocol of this project received a favourable opinion from the West Midlands South Birmingham Research Ethics Committee (16/WM/0423). Results will be submitted for publication in peer-reviewed journals and at conferences, and disseminated via newsletters and social media of our clinical collaborators and miscarriage charities. Outputs are anticipated to inform future policy and practice in the management of multiple miscarriages. TRIAL REGISTRATION NUMBER ISRCTN 21828561.
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Affiliation(s)
- Helen Marie Williams
- Tommy's National Centre for Miscarriage Research, University of Birmingham, Birmingham, UK
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Laura L Jones
- Tommy's National Centre for Miscarriage Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Arri Coomarasamy
- Tommy's National Centre for Miscarriage Research, University of Birmingham, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Annie E Topping
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Jones K, Robb M, Murphy S, Davies A. New understandings of fathers’ experiences of grief and loss following stillbirth and neonatal death: A scoping review. Midwifery 2019; 79:102531. [DOI: 10.1016/j.midw.2019.102531] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 08/16/2019] [Accepted: 08/21/2019] [Indexed: 10/26/2022]
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Banno C, Sugiura-Ogasawara M, Ebara T, Ide S, Kitaori T, Sato T, Ando K, Morita Y. Attitude and perceptions toward miscarriage: a survey of a general population in Japan. J Hum Genet 2019; 65:155-164. [PMID: 31761902 DOI: 10.1038/s10038-019-0694-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/30/2019] [Accepted: 10/30/2019] [Indexed: 11/09/2022]
Abstract
Miscarriage is the greatest complication of pregnancy, and 70-80% of early miscarriages are mostly due to chromosomal abnormalities in the embryo. There is no evidence that stress is a direct cause of miscarriage. Despite these findings, in a national US survey on the causes of miscarriage, many Americans mistakenly attributed miscarriage to the mental state or behavior of the women. We conducted a survey to assess public attitudes and perceptions regarding the cause and prevalence of miscarriage in Japan. We sent out a questionnaire consisting of 17 questions. The 5000 recipients consisted of men and women (1:1 ratio) aged 18-69 who resided in Aichi Prefecture. A total of 1257 recipients (25%) responded to the questionnaire and 1219 valid respondents (24%) were included in the analyses. Of these, 62% considered a genetic abnormality of the fetus as the cause of miscarriage. Participants who were female, highly educated, married and healthy gave significantly more correct responses. On the other hand, the majority wrongly assumed that a stressful event (65%) and long-standing stress (75%) to be causes of miscarriage. Participants who had no history of miscarriage as well as males answered significantly more incorrectly. Sixty-five percent of respondents thought that miscarriage occurred less than 15% of all pregnancies. Among respondents who had experienced miscarriage personally, 53 and 36% felt guilty and lonely, respectively. Many respondents blamed the woman for the miscarriage either in terms of her behavior or mental stress and considered the frequency of miscarriage to be lower than it actually is.
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Affiliation(s)
- Chihiro Banno
- Department of Obstetrics and Gynecology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Mayumi Sugiura-Ogasawara
- Department of Obstetrics and Gynecology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan.
| | - Takeshi Ebara
- Department of Occupational and Environmental Health, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Shoko Ide
- Department of Obstetrics and Gynecology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Tamao Kitaori
- Department of Obstetrics and Gynecology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Takeshi Sato
- Department of Obstetrics and Gynecology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Kiwamu Ando
- Graduate School of Humanities and Social Sciences, Nagoya City University, Nagoya, Japan
| | - Yoko Morita
- Graduate School of Economics, Nagoya City University, Nagoya, Japan
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Chen SL, Chang SM, Kuo PL, Chen CH. Stress, anxiety and depression perceived by couples with recurrent miscarriage. Int J Nurs Pract 2019; 26:e12796. [PMID: 31713284 DOI: 10.1111/ijn.12796] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 06/25/2019] [Accepted: 09/22/2019] [Indexed: 11/29/2022]
Abstract
AIM Recurrent miscarriage is considered a major life event. The main purposes of this study were to compare the differences in stress, anxiety, social support, sleep quality and depressive symptoms in couples experiencing recurrent miscarriage compared to peers who experience full-term normal childbirth in southern Taiwan. METHODS Convenience sampling and snowball sampling were used respectively to recruit 78 couples with and 80 couples without recurrent miscarriage from October 2014 to July 2015. Five structured questionnaires including Perceived Stress Scale, State- Anxiety Inventory, Interpersonal Support Evaluation List, Pittsburgh Sleep Quality Index and Edinburgh Depression Scale were administered. RESULTS Women who experienced recurrent miscarriage perceived significantly higher levels of stress, anxiety and depressive symptoms than their husbands. Women in the recurrent miscarriage group reported significantly greater depressive symptoms than women of the other group. A stepwise multiple regression analysis indicated key predictors of depressive symptoms among women of childbearing age, accounting for 62.9% of the variance, were anxiety, stress, social support and history of recurrent miscarriage. CONCLUSION Women with recurrent miscarriage suffer mild to moderate depressive symptoms and a greater incidence of depression than their peers who experienced normal childbirth. Health professionals can use the knowledge gained from these findings to evaluate women with recurrent miscarriage for stress, anxiety and depressive symptoms and develop supportive interventions.
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Affiliation(s)
- Shu-Lan Chen
- Department of Nursing, Fooyin University, Kaohsiung, Taiwan
| | - Shao-Min Chang
- Department of Nursing, Fooyin University, Kaohsiung, Taiwan
| | - Pao-Lin Kuo
- Department of Obstetrics and Gynecology, College of Medicine, National Cheng-Kung University, Tainan, Taiwan
| | - Chung-Hey Chen
- Department of Nursing, HungKuang University, Taichung, Taiwan.,Department of Nursing & Institute of Allied Health Sciences, National Cheng Kung University, Tainan, Taiwan
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Adib-Rad H, Basirat Z, Faramarzi M, Mostafazadeh A, Bijani A. Psychological distress in women with recurrent spontaneous abortion: A case-control study. Turk J Obstet Gynecol 2019; 16:151-157. [PMID: 31673466 PMCID: PMC6792057 DOI: 10.4274/tjod.galenos.2019.88899] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/09/2019] [Indexed: 12/29/2022] Open
Abstract
Objective The aim of the present study was to evaluate psychological problems in women with recurrent spontaneous abortion (RSA). Materials and Methods In this case-control study, 115 women with RSA were assigned to the case group and 240 non-pregnant women comprised the control group. The revised version of the Symptom Checklist-90 (SCL-90-R) and the Intolerance of Uncertainty scale (IUS) were used for assessing mental health problems. Results The results showed that the mean Global Severity Index (GSI) of the SCL-90-R and the IUS scores in the case and control groups were 109.10±59.85 and 68.91±22.17, and 82.98±52.99 and 59.19±23.01, respectively. GSI was the strongest predictor of RSA [odds ratio (OR)=6.43; 95% confidence interval (CI): 3.52-11.72]. The chance estimate of RSA was approximately 2.1 times higher in women in rural areas (OR=2.07; 95% CI: 1.16-3.69), and 2 times higher at 12 months after the last pregnancy (OR=1.99; 95% CI: 1.42-2.78). Conclusion Psychological problems are greater after RSA. Therefore, it is suggested that the treatment of RSA emphasizes psychological counseling and psychological management.
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Affiliation(s)
- Hajar Adib-Rad
- Babol University of Medical Sciences, Institute of Health Research, Infertility and Reproductive Health Research Center, Babol, Iran
| | - Zahra Basirat
- Babol University of Medical Sciences, Institute of Health Research, Infertility and Reproductive Health Research Center, Babol, Iran
| | - Mahbobeh Faramarzi
- Babol University of Medical Sciences, Institute of Health Research, Infertility and Reproductive Health Research Center, Babol, Iran
| | - Amrollah Mostafazadeh
- Babol University of Medical Sciences, Institute of Health Research, Cellular and Molecular Biology Research Center, Babol, Iran
| | - Ali Bijani
- Babol University of Medical Sciences, Institute of Health Research, Social Determinants of Health Research Center, Babol, Iran
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He L, Wang T, Xu H, Chen C, Liu Z, Kang X, Zhao A. Prevalence of depression and anxiety in women with recurrent pregnancy loss and the associated risk factors. Arch Gynecol Obstet 2019; 300:1061-1066. [DOI: 10.1007/s00404-019-05264-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
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26
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Morita K, Ono Y, Takeshita T, Sugi T, Fujii T, Yamada H, Nakatsuka M, Fukui A, Saito S. Risk Factors and Outcomes of Recurrent Pregnancy Loss in Japan. J Obstet Gynaecol Res 2019; 45:1997-2006. [PMID: 31397532 DOI: 10.1111/jog.14083] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/13/2019] [Indexed: 12/13/2022]
Abstract
AIM To clarify the risk factors and pregnancy outcomes for each risk factor of recurrent pregnancy loss (RPL) in Japan. METHODS Using a prospective RPL database collected from 16 facilities in Japan, the prevalence of risk factors for RPL, their treatments and pregnancy outcomes were examined. RESULTS Of 6663 patients registered in our database, 5708 patients had RPL. All examinations for risk factors were performed for 1340 patients (23.5%). The prevalences of positive antiphospholipid antibodies (aPL), malformation of the uterus, thyroid dysfunction, parental karyotype abnormality, factor XII deficiency, protein S deficiency and unknown risk factors were 8.7%, 7.9%, 9.5%, 3.7%, 7.6%, 4.3% and 65.1%, respectively. Although factor XII deficiency and protein S deficiency are not recognized as risk factors for RPL in general, low-dose aspirin (LDA) or unfractionated heparin + LDA therapy improved live birth rates. In transiently aPL-positive patients, the live birth rate with LDA therapy was similar to that with heparin + LDA. For unknown risk factors of RPL, the live birth rate in normal fetal karyotype in the none treatment group was similar to that in all other treatments group (81.3% vs 86.0%). Of 5708 RPL patients, pregnancy outcomes were known for 2261 patients and 1697 patients (75.1%) had at least one live birth. CONCLUSION The risk factors and pregnancy outcomes for each risk factor of RPL are useful for clinicians and patients. Factor XII deficiency and protein S deficiency may be risk factors of RPL.
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Affiliation(s)
- Keiko Morita
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Yosuke Ono
- Department of Obstetrics and Gynecology, Tonami General Hospital, Tonami, Toyama, Japan
| | - Toshiyuki Takeshita
- Department of Obstetrics and Gynecology, Nippon Medical School, Bunkyo City, Tokyo, Japan
| | - Toshitaka Sugi
- Laboratory for Recurrent Pregnancy Loss, Sugi Women's Clinic, Yokohama, Kanagawa, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, University of Tokyo, Bunkyo City, Tokyo, Japan
| | - Hideto Yamada
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Mikiya Nakatsuka
- Graduate School of Health Sciences, Okayama University, Okayama, Japan
| | - Atsushi Fukui
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Shigeru Saito
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
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Wie JH, Nam SK, Ko HS, Shin JC, Park IY, Lee Y. The association between abortion experience and postmenopausal suicidal ideation and mental health: Results from the 5th Korean National Health and Nutrition Examination Survey (KNHANES V). Taiwan J Obstet Gynecol 2019; 58:153-158. [PMID: 30638471 DOI: 10.1016/j.tjog.2018.11.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2018] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The association between abortion and postmenopausal mental health has not been clearly established in Asian women. The objective of this study was to evaluate the effect of abortion experiences on suicidal ideation and mental health in Korean postmenopausal women. MATERIALS AND METHODS This study included 5133 postmenopausal women registered in the Korean National Health and Nutrition Examination Survey between 2010 and 2012. Difference in suicidal ideation according to type and number of abortions was analyzed. We used survey multiple logistic regression analysis to evaluate the effect of abortion experiences on the risk for suicidal ideation expressed as adjusted odd ratios (ORs) with 95% confidence intervals (95%CIs). RESULTS The risk of suicidal ideation was significantly higher in women who experienced more than three abortions (27.9%). While the incidence of suicidal ideation was not significantly affected by the number of spontaneous abortions (p = 0.718), suicidal ideation was significantly more frequent in women who had undergone ≥ three abortions (p = 0.003). After adjusting for demographic confounding factors, women who underwent ≥ three induced abortions had higher risk for suicidal ideation (OR: 1.510; 95% CI: 1.189-1.919; p = 0.031). This risk remained elevated even after controlling for depression (OR: 1.391; 95% CI: 1.1086-1.871, p = 0.002). Moreover, the risk of experiencing a depressive mood in daily life was also increased with increasing number of induced abortions even after controlling for depression (OR: 1.657; 95% CI: 1.274-2.156, p = 0.002). CONCLUSION Undergoing three or more induced abortions during reproductive age was associated with postmenopausal suicidal ideation, stress, and depression. However, such association was not noted in those with spontaneous abortion, even in women with more miscarriages. Thus, clinicians should evaluate depression and suicidal ideation in women with multiple induced abortions.
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Affiliation(s)
- Jeong Ha Wie
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Su Kyung Nam
- Department of Obstetrics and Gynecology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Sun Ko
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Chul Shin
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Yang Park
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Lee
- Department of Obstetrics and Gynecology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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McLaughlin M, Cassidy T. Psychosocial predictors of IVF success after one year: a follow-up study. J Reprod Infant Psychol 2018; 37:311-321. [PMID: 30585083 DOI: 10.1080/02646838.2018.1560398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: There is growing evidence that psychosocial factors play an important role in the success of in-vitro fertilisation (IVF). The current study explored the impact of coping style, social support, self-compassion, parenthood motivation and relationship attachment as predictors of IVF success. Design: A follow-up survey of 305 women undergoing IVF who had initially been assessed one year earlier. Methods: Participants were assessed on measures of coping style, social support, self-compassion, parenthood motivation, relationship attachment and psychological distress and reassessed one year later in terms of the outcome of IVF. Results: Of these, 156 reported successful births while 149 had been unsuccessful. Of the 149 who had been unsuccessful, 66 were undertaking another cycle of IVF and 83 were not, although whether they had completely given up is not known. The significant positive predictors were problem-focused coping, mindfulness, nurturance motivation, secure attachment, support from friends and self-kindness. In addition, social pressure motivation, and avoidance coping were negative predictors. Conclusions: The findings point to potential psychological interventions in terms of stress management, couple counselling and mindfulness therapy in increasing the likelihood of success from IVF.
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Affiliation(s)
- Marian McLaughlin
- a Psychology Research Institute , Ulster University , Coleraine , Northern Ireland
| | - Tony Cassidy
- a Psychology Research Institute , Ulster University , Coleraine , Northern Ireland
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Passet-Wittig J, Schneider NF. Imaginability of adoption, foster care, and life without a(nother) child and stress in women and men in fertility treatment. J Health Psychol 2018; 25:1462-1471. [PMID: 29493286 DOI: 10.1177/1359105318758857] [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: 11/15/2022] Open
Abstract
We study whether the imaginability of adoption, foster care, and life without a(nother) child protects from stress during fertility treatment. Data from a self-administered prospective cohort study of couples who had just started treatment were used (T1 = 441 respondents; T2 = 142 respondents). Most respondents cannot imagine alternatives to treatment. Adoption/foster care is preferred over life without children. Imaginability of alternatives is associated with lower fertility-related (T1) and treatment-related stress (T2). Experience of a pregnancy/birth does not moderate the association. Thus, the availability of alternatives to treatment turns out to be helpful in terms of self-regulation during fertility treatment.
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Due C, Chiarolli S, Riggs DW. The impact of pregnancy loss on men's health and wellbeing: a systematic review. BMC Pregnancy Childbirth 2017; 17:380. [PMID: 29141591 PMCID: PMC5688642 DOI: 10.1186/s12884-017-1560-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/03/2017] [Indexed: 12/03/2022] Open
Abstract
Background Research indicates that men’s psychological and physical health outcomes after pregnancy loss differ from those of women. Our goal was to identify all literature with a focus on men’s experiences of pregnancy loss in order to outline current evidence concerning men’s wellbeing. Methods A systematic review of literature on men and pregnancy loss was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), Joanna Briggs Institute (JBI) and Social Care Institute for Excellence (SCIE) guidelines. Literature was sourced from PsycINFO, PubMed, Scopus, CINAHL, and Google Scholar. Inclusion criteria were 1) studies that focused on pregnancy loss (including miscarriage, stillbirth, and ectopic pregnancy, 2) that men’s voices were specifically represented, and 3) that studies were of primary data. Results A final sample of 29 articles was identified, of which 16 were quantitative, 10 qualitative, and 3 mixed methods. Quantitative and mixed methods studies indicated that while men tended to have less intense and less enduring levels of negative psychological outcomes than women, they are more likely to engage in compensatory behaviours, such as increased alcohol consumption. Qualitative studies indicated that men often feel that their role is primarily as a ‘supporter’ to their female partner, and that this precludes recognition of their own loss. These studies also reported that men may feel overlooked and marginalised in comparison to their female partners, whose pain is typically more visible. Conclusions Further research is needed on men’s experiences of pregnancy loss, focusing on cultural differences. The experience of gay and/or transgender men who face pregnancy loss is overlooked in the literature to date.
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Affiliation(s)
- Clemence Due
- School of Psychology, The University of Adelaide, Adelaide, South Australia, 5005, Australia.
| | - Stephanie Chiarolli
- School of Psychology, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Damien W Riggs
- School of Social and Policy Studies, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia
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Abstract
OBJECTIVE The objective of the study was to explore the experiences of those who have experienced miscarriage, focusing on men's and women's accounts of miscarriage. DESIGN This was a qualitative study using a phenomenological framework. Following in-depth semistructured interviews, analysis was undertaken in order to identify superordinate themes relating to their experience of miscarriage. SETTING A large tertiary-level maternity hospital in Ireland. PARTICIPANTS A purposive sample of 16 participants, comprising 10 women and 6 men, was recruited. RESULTS 6 superordinate themes in relation to the participant's experience of miscarriage were identified: (1) acknowledgement of miscarriage as a valid loss; (2) misperceptions of miscarriage; (3) the hospital environment, management of miscarriage; (4) support and coping; (5) reproductive history; and (6) implications for future pregnancies. CONCLUSIONS One of the key findings illustrates a need for increased awareness in relation to miscarriage. The study also indicates that the experience of miscarriage has a considerable impact on men and women. This study highlights that a thorough investigation of the underlying causes of miscarriage and continuity of care in subsequent pregnancies are priorities for those who experience miscarriage. Consideration should be given to the manner in which women who have not experienced recurrent miscarriage but have other potential risk factors for miscarriage could be followed up in clinical practice.
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Affiliation(s)
- S Meaney
- National Perinatal Epidemiology Centre, University College Cork, Ireland
- Pregnancy Loss Research Group, Dept. of Obstetrics and Gynaecology, University College Cork, Ireland
| | - P Corcoran
- National Perinatal Epidemiology Centre, University College Cork, Ireland
| | - N Spillane
- Pregnancy Loss Research Group, Dept. of Obstetrics and Gynaecology, University College Cork, Ireland
| | - K O'Donoghue
- Pregnancy Loss Research Group, Dept. of Obstetrics and Gynaecology, University College Cork, Ireland
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Ireland
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Sobral MP, Costa ME, Schmidt L, Martins MV. COMPI Fertility Problem Stress Scales is a brief, valid and reliable tool for assessing stress in patients seeking treatment. Hum Reprod 2016; 32:375-382. [PMID: 27979919 DOI: 10.1093/humrep/dew315] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/27/2016] [Accepted: 11/15/2016] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Are the Copenhagen Multi-Centre Psychosocial Infertility research program Fertility Problem Stress Scales (COMPI-FPSS) a reliable and valid measure across gender and culture? SUMMARY ANSWER The COMPI-FPSS is a valid and reliable measure, presenting excellent or good fit in the majority of the analyzed countries, and demonstrating full invariance across genders and partial invariance across cultures. WHAT IS KNOWN ALREADY Cross-cultural and gender validation is needed to consider a measure as standard care within fertility. The present study is the first attempting to establish comparability of fertility-related stress across genders and countries. STUDY DESIGN SIZE, DURATION Cross-sectional study. First, we tested the structure of the COMPI-FPSS. Then, reliability and validity (convergent and discriminant) were examined for the final model. Finally, measurement invariance both across genders and cultures was tested. PARTICIPANTS/MATERIALS, SETTING, METHODS Our final sample had 3923 fertility patients (1691 men and 2232 women) recruited in clinical settings from seven different countries: Denmark, China, Croatia, Germany, Greece, Hungary and Sweden. Participants had a mean age of 34 years and the majority (84%) were childless. MAIN RESULTS AND THE ROLE OF CHANCE Findings confirmed the original three-factor structure of the COMPI-FPSS, although suggesting a shortened measurement model using less items that fitted the data better than the full version model. While data from the Chinese and Croatian subsamples did not fit, all other counties presented good fit (χ2/df ≤ 5.4; comparative fit index ≥ 0.94; root-mean-square error of approximation ≤ 0.07; modified expected cross-validation index ≤ 0.77). In general, reliability, convergent validity, and discriminant validity were observed in all subscales from each country (composite reliability ≥ 0.63; average variance extracted ≥ 0.38; squared correlation ≥ 0.13). Full invariance was established across genders, and partial invariance was demonstrated across countries. LIMITATIONS REASONS FOR CAUTION Generalizability regarding the validation of the COMPI-FPSS cannot be made regarding infertile individuals not seeking treatment, or non-European patients. This study did not investigate predictive validity, and hence the capability of this instrument in detecting changes in fertility-specific adjustment over time and predicting the psychological impact needs to be established in future research. WIDER IMPLICATIONS OF THE FINDINGS Besides extending knowledge on the psychometric properties of one of the most used fertility stress questionnaire, this study demonstrates both research and clinical usefulness of the COMPI-FPSS. STUDY FUNDING/COMPETING INTERESTS This study was supported by European Union Funds (FEDER/COMPETE-Operational Competitiveness Program, and by national funds (FCT-Portuguese Foundation for Science and Technology) under the projects PTDC/MHC-PSC/4195/2012 and SFRH/BPD/85789/2012). There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Maria P Sobral
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal
| | - Maria E Costa
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal.,Center for Psychology at University of Porto, 4200-135 Porto, Portugal
| | - Lone Schmidt
- Department of Public Health, University of Copenhagen, Section of Social Medicine, 1014 København K, Denmark
| | - Mariana V Martins
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal .,Center for Psychology at University of Porto, 4200-135 Porto, Portugal
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Couples and Miscarriage: The Influence of Gender and Reproductive Factors on the Impact of Miscarriage. Womens Health Issues 2015; 25:570-8. [DOI: 10.1016/j.whi.2015.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 04/06/2015] [Accepted: 04/10/2015] [Indexed: 12/13/2022]
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Kolte AM, Olsen LR, Mikkelsen EM, Christiansen OB, Nielsen HS. Depression and emotional stress is highly prevalent among women with recurrent pregnancy loss. Hum Reprod 2015; 30:777-82. [PMID: 25662810 DOI: 10.1093/humrep/dev014] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is the prevalence of psychological stress and moderate/severe depression higher for women with recurrent pregnancy loss (RPL) than pregnancy planners trying to conceive naturally? SUMMARY ANSWER Both psychological stress and major depression are significantly more common among women with RPL than in those trying to conceive naturally. WHAT IS KNOWN ALREADY RPL has a significant emotional impact on couples, especially the woman. Previous studies have shown inconclusive results. STUDY DESIGN, SIZE, DURATION In this cross-sectional study, we compared the prevalence of stress and depression among 301 women with RPL and 1813 women attempting to conceive naturally. We defined RPL as three or more pregnancy losses before 12 weeks' gestation. RPL patients were enrolled from 2010 to 2013 and the comparison group from 2011 to 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS RPL patients completed an online questionnaire before their first consultation at the Danish RPL Unit. In addition, we included data from a comparison group of 1813 women who participated in the Soon Parents Study (www.SnartForældre.dk). The Major Depression Index (MDI) was used to assess symptoms of depression, and Cohen's Perceived Stress Scale (PSS) was used to measure stress. Relevant demographic data were also retrieved. MAIN RESULTS AND THE ROLE OF CHANCE Of the RPL patients, 26 (8.6%) had a score on the MDI corresponding to moderate/severe depression, as did 40 (2.2%) of the women in Soon Parents Study (adjusted odds ratio (OR) 5.53 (95% confidence interval (CI): 2.09; 14.61)). A high stress level, defined as ≥19 on the PSS scale, was reported by 124 (41.2%) of the patients and 420 (23.2%) in the comparison group (adjusted OR 1.59 (95% CI 1.03; 2.44)). LIMITATIONS, REASONS FOR CAUTION We used online questionnaires, and have no interview data. We were unaware if any of the women in the comparison group suffer from RPL. WIDER IMPLICATIONS OF THE FINDINGS This study should entail a heightened awareness of mental distress among care providers for women with RPL. STUDY FUNDING/COMPETING INTERESTS No specific funding was sought for this study. The Soon Parents Study is funded by National Institute of Child Health and Human Development (R01 HD060680-01A4). No authors have competing interests to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- A M Kolte
- Recurrent Pregnancy Loss Unit, Fertility Clinic 4071, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - L R Olsen
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - E M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - O B Christiansen
- Recurrent Pregnancy Loss Unit, Fertility Clinic 4071, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark Department of Obstetrics and Gynaecology, Aalborg Hospital, Aalborg, Denmark
| | - H S Nielsen
- Recurrent Pregnancy Loss Unit, Fertility Clinic 4071, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
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Altered autonomic nervous system activity in women with unexplained recurrent pregnancy loss. J Obstet Gynaecol Res 2014; 41:912-8. [DOI: 10.1111/jog.12653] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 10/24/2014] [Indexed: 11/26/2022]
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Abstract
A recurrent miscarriage clinic offers specialist investigation and treatment of women with recurrent first- and second-trimester miscarriages. Consultant-led clinics provide a dedicated and focused service to couples who have experienced at least two prior miscarriages. The best treatment strategy for couples with recurrent miscarriage is to discuss a treatment plan for a future pregnancy. Evidence-based up-to-date guidelines are required to reduce ineffective management of recurrent miscarriage couples, including overdiagnostics and underdiagnostics. Scientific research is necessary to study the effectiveness of new interventions, to study patient preferences, and to evaluate health care and costs or other outcomes.
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Affiliation(s)
- M M J Van den Berg
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Academic Medical Center, H4-205, PO Box 22660, Amsterdam 1100 DD, The Netherlands
| | - Rosa Vissenberg
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Academic Medical Center, H4-205, PO Box 22660, Amsterdam 1100 DD, The Netherlands
| | - Mariëtte Goddijn
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Academic Medical Center, H4-205, PO Box 22660, Amsterdam 1100 DD, The Netherlands.
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Current World Literature. Curr Opin Obstet Gynecol 2013. [DOI: 10.1097/gco.0b013e32835f3eec] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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