Depressive Symptoms and Health-Related Quality of Life in Early Pregnancy

The long-term association between exposure to wartime bombing earlier in life and post-traumatic stress later in life among today's older Vietnamese population

This analysis examines the relationship between exposure to American wartime bombardments earlier in life and later-life PTSD among current surviving Vietnamese aged 59+. It also assesses whether the relationship varies by military status during the war - formal military, informal military, or civilian - and whether associations are explained by exposure to violence and malevolent conditions. Data link survey responses from the 2018 Vietnam Health and Aging Study to provincial-wide level bombing intensity using U.S. Department of Defense records from the Theater History of Operations Vietnam database. PTSD measured using nine items from the PTSD Checklist. Analyses employ multivariate logistic quantile regression. Findings examined for a sample of 2290 Vietnamese survivors and a subsample of 736 Vietnamese that moved at least once during wartime. Results show a robust and significant positive association between province-wide bombing intensity and later-life PTSD scores. Interaction effects indicate civilians have overall lower levels of PTSD than those that were in the formal or informal military, but the association between bombing and PTSD is stronger among civilians. Much of the association is a function of exposure to violence and less is a function of exposure to malevolent conditions. Findings confirm earlier studies that have shown severe deleterious impacts of war trauma, and arial bombardments particularly, on long-term psychological health, while extending extant literature to civilian populations living in Vietnam during intense aerial bombing episodes.

Cognitive function following early life war-time stress exposure in a cohort of Vietnamese older adults

Although Alzheimer's Disease is a leading cause of death in Vietnam and other post-conflict, low- and middle-income countries, aside from studies of veterans in western populations, research on war-related violence and deprivation as risk factors for cognitive disorders remains sparse. Using data from the Vietnam Health and Aging Study, which relied upon a multistage probability sample of 2447 older adults residing in districts of northern Vietnam differentially exposed to wartime bombing and numerous war-related stressors, this paper investigates associations between early-life war-related stressors and later-life cognitive function in a cohort whose transition to adulthood took place during the American-Vietnam War. Relationships among experiences of severe childhood hunger, war-related violence and environmental hardships, military service, and cognitive function in an analytical sample of 2162 Vietnamese older adults are estimated using quantile regression. Cognitive function is assessed by a modified Mini-Mental State Examination (MMSE) score. Analyses also address posttraumatic stress disorder (PTSD), cardiovascular health, and health behaviors as potential mediators between early life war-related stressors and current cognitive function. Results indicate that experiences of severe hunger in childhood and environmental hardships are associated with poorer cognitive function in older adulthood. PTSD, cardiovascular risk (i.e., hypertension) and disease (i.e., stroke), each of which is heightened by exposure to wartime stressors, are associated with lower cognitive scores. Results suggest that certain war exposures, like involvement in combat duties, are associated with higher cognitive function scores, suggesting that military service either positively selects for cognitive function, or certain forms of service may impart cognitive resilience. Following recent calls to incorporate population-specific stressors to advance explanatory models of cognitive function, these findings suggest that it is critical to assess the enduring scars and resilience of armed conflict in global efforts to understand, prevent, and treat cognitive impairment, Alzheimer's Disease, and related dementias.

Longitudinal study of the relationship between number of prior miscarriages or stillbirths and changes in quality of life of pregnant women: the Japan Environment and Children's Study (JECS)

BACKGROUND

Although a history of miscarriage or stillbirth has been reported to negatively affect quality of life (QOL) during the subsequent pregnancy, the association between the number of previous miscarriages or stillbirths and QOL, as well as trends in QOL during pregnancy, has not been clarified. This study sought to determine this association during early and mid- to late pregnancy.

METHODS

Data from 82,013 pregnant women who participated in the Japan Environment and Children's Study (JECS) from January 2011 to March 2014 were analyzed. In early and mid/late pregnancy, participants completed questionnaires and QOL was assessed using the Physical and Mental Component Summary (PCS and MCS, respectively) scores from the 8-item Short-Form Health Survey (SF-8). The pregnant women were divided into four groups according to number of previous miscarriages or stillbirths (0, 1, 2, and ≥ 3), and the PCS and MCS scores in early pregnancy and mid/late pregnancy were compared between group 0 and groups 1, 2, and ≥ 3. Generalized linear mixed models were used for analysis.

RESULTS

PCS score in early pregnancy was lower in group 1 (β =  - 0.29, 95% confidence interval [CI] - 0.42 to - 0.15), group 2 (β =  - 0.45, 95% CI - 0.73 to - 0.18), and group ≥ 3 (β =  - 0.87, 95% CI - 1.39 to - 0.35) than in group 0. Group 1 and group ≥ 3 showed a trend for increased PCS score during pregnancy (β = 0.22, 95% CI 0.07 to 0.37 and β = 0.75, 95% CI 0.18 to 1.33, respectively) compared with group 0.

CONCLUSIONS

PCS score in early pregnancy was lower with a more frequent history of miscarriage or stillbirth. However, in terms of changes in QOL during pregnancy, pregnant women with a history of miscarriage or stillbirth showed greater increases in PCS score during mid/late pregnancy than pregnant women with no history of miscarriage or stillbirth.

Postpartum quality of life and associated factors: a cross-sectional study

PURPOSE

To determine factors associated with postpartum quality of life (QOL).

METHODS

An analytic cross-sectional design was used in this study, and data was collected from December 2019 to March 2020. Participants were 252 postpartum women visiting eight governmental primary healthcare centers in Madinah city, Saudi Arabia. Data were collected using a sociodemographic questionnaire, the World Health Organization Quality of Life Assessment-BREF, Multidimensional Scale of Perceived Social Support (MSPSS), and Edinburgh Postnatal Depression Scale. Sleep problems were assessed using an item from the Prime-MD Patient Health Questionnaire.

RESULTS

Maternal age between 26 and 35 years had a significant independent association with the physical health domain of QOL (p < .01). Postpartum depression was significantly associated with lower QOL in all dimensions (p < .01). In addition, sleep problems were associated with three out of the four QOL domains (p < .05). The significant other subscale of the MSPSS was significantly associated with higher QOL scores in all dimensions (p < .01); additionally, family and friends subscales of the MSPSS were significantly associated with the social domain of QOL (p < .01).

CONCLUSIONS

Maternal QOL, during the postpartum period, showed negative associations with age, postpartum depression, and sleep disturbances. Ultimately, social support appeared to be an essential factor in mothers' ability to cope with the physical and psychological problems experienced during this period.

Prevalence and risk factors of anxious and depressive symptoms in first-trimester females and their partners: a study during the pandemic era of COVID-19 in China

BACKGROUND

The pandemic of coronavirus disease 2019 lastingly affects public mental health. Many studies have described symptoms of anxiety and depression in pregnant women before the pandemic. However, the limited study focuses on the prevalence and risk factors of mood symptoms among first-trimester females and their partners during the pandemic in China, which was the aim of the study.

METHODS

One hundred and sixty-nine first-trimester couples were enrolled. The Edinburgh Postnatal Depression Scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-Item, Family Assessment Device-General Functioning (FAD-GF), and Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form (Q-LES-Q-SF) were applied. Data were mainly analyzed through logistic regression analysis.

RESULTS

17.75% and 5.92% of first-trimester females had depressive and anxious symptoms, respectively. Among partners, 11.83% and 9.47% had depressive and anxious symptoms, respectively. In females, higher scores of FAD-GF (OR = 5.46 and 13.09; P < 0.05) and lower scores of Q-LES-Q-SF (OR = 0.83 and 0.70; P < 0.01) were related to the risk of depressive and anxious symptoms. Higher scores of FAD-GF were associated with the risk of depressive and anxious symptoms in partners (OR = 3.95 and 6.89; P < 0.05). A history of smoking was also related to males' depressive symptoms (OR = 4.49; P < 0.05).

CONCLUSION

This study prompted prominent mood symptoms during the pandemic. Family functioning, quality of life, and smoking history increased risks of mood symptoms among early pregnant families, which facilitated the updating of medical intervention. However, the current study did not explore interventions based on these findings.

Meeting physical activity guidelines and its association with health-related quality of life throughout pregnancy: the PregnActive project

Pregnancy is a unique period in women life, characterized by anatomical and metabolic variation that may affect health-related quality of life (HRQoL). Physical activity has the potential to positively influence HRQoL. The aim of this study is to analyze the association between the fulfillment of physical activity guidelines and HRQoL throughout pregnancy. Seventy-eight pregnant women were assessed at two time point through their pregnancy: at mid- and at later-pregnancy. Physical activity was objectively assessed by a multi-sensor monitor and pregnant women were categorized by the fulfillment of the minimum physical activity recommendations: at least 30 minutes/day on at least 5 days/week. Perceived mental health was evaluated by health-related quality of life and by psychological pregnancy symptoms, using the SF-36 and the Pregnancy Symptoms Inventory, respectively. T-Student Test and hierarchical multiple linear regressions analysis was developed. Pregnant women who fulfilled physical activity recommendations reported better mental HRQoL both at mid-pregnancy (p = 0.148) and later-pregnancy (p = 0.007). The number of days meeting minimum physical activity recommendations contributes to better mental HRQoL and together with depression and anxiety symptoms the model explain the 65% of the mental HRQoL at later pregnancy. Meeting the minimum physical activity recommendations is associated with better perceived health at both midpregnancy and later pregnancy. While mental HRQoL is explained by physical activity, physical HRQoL is explained by others factors such as age or pregnancy-related symptoms, but not by meeting the minimum physical activity recommendations.

The Prevalence of the Risk of Sexual Dysfunction in the First and Third Trimesters of Pregnancy in a Sample of Spanish Women

Sexuality is a central aspect for all human beings. Research into the prevalence of sexual dysfunction in pregnant Spanish women is scarce. The aim of this work is to examine the prevalence of risk of sexual dysfunctions in pregnant Spanish women and determine in which trimester the greatest difficulties in sexual response occur. The sample consisted of 180 pregnant Spanish women, with an average age of 32.03 years (SD = 4.93). The participants completed a questionnaire for socio-demographic data, as well as the female sexual function index, the state/trait depression inventory, and the dyadic adjustment scale. The results indicate that the percentage of women with a risk of sexual dysfunction was 65% in the first trimester and 81.11% in the third trimester. Likewise, the highest score on the depression questionnaire was in the third trimester, and the couple's relationship also improved in the third trimester. To improve women's sex lives during pregnancy, it is recommended to increase sexual education and information for both pregnant women and their partners.

Quality of Life and Depression Conditions of Women with Gestational Diabetes during Pregnancy and Postpartum Period

OBJECTIVE

 The study was conducted to determine the quality of life and depression of women with gestational diabetes during pregnancy and the postpartum period.

METHODS

 100 pregnant women with gestational diabetes and 100 healthy pregnant women were included in the present study. Data were obtained from pregnant women in their third trimester who agreed to take part in the study. The data was collected during the third trimester and six to eight weeks after the baby was born. The data were obtained by socio-demographic characteristics form, postpartum data collection form, the MOS 36 Item Short Form Health Survey and Center for Epidemiologic Studies Depression Scale (CESD).

RESULTS

 The mean age of pregnant women with gestational diabetes in the study was the same as the average age of healthy pregnant women. The CESD score of pregnant women with gestational diabetes was 26,77 ± 4,85 while the corresponding score was 25,19 ± 4,43 for healthy women. Additionally, the score in the postpartum period was 32.47 ± 5.94 for pregnant women with gestational diabetes and 35.47 ± 8.33 for healthy pregnant women. CESD scores were found to be higher than the cut-off score of 16 in both groups, and the mean scores increased during the postpartum period.

CONCLUSION

 During the postpartum period, the quality of life of pregnant women with gestational diabetes was affected more negatively than healthy pregnant women. Depressive symptoms of women with both gestational diabetes and healthy pregnancy were found to be high in pregnancy and postpartum periods.

An examination of the association between marital status and prenatal mental disorders using linked health administrative data

Background

International research shows marital status impacts the mental health of pregnant women, with prenatal depression and anxiety being higher among non-partnered women. However, there have been few studies examining the relationship between marital status and prenatal mental disorders among Australian women.

Methods

This is a population-based retrospective cohort study using linked data from the New South Wales (NSW) Perinatal Data Collection (PDC) and Admitted Patients Data Collection (APDC). The cohort consists of a total of 598,599 pregnant women with 865,349 admissions. Identification of pregnant women for mental disorders was conducted using the 10^th version International Classification of Diseases and Related Health Problems, Australian Modification (ICD-10-AM). A binary logistic regression model was used to estimate the relationship between marital status and prenatal mental disorder after adjusting for confounders.

Results

Of the included pregnant women, 241 (0.04%), 107 (0.02%) and 4359 (0.5%) were diagnosed with depressive disorder, anxiety disorder, and self-harm, respectively. Non-partnered pregnant women had a higher likelihood of depressive disorder (Adjusted Odds Ratio (AOR) = 2.75; 95% CI: 2.04, 3.70) and anxiety disorder (AOR = 3.16, 95% CI: 2.03, 4.91), compared with partnered women. Furthermore, the likelihood of experiencing self-harm was two times higher among non-partnered pregnant women (AOR = 2.00; 95% CI: 1.82, 2.20) than partnered pregnant women.

Conclusions

Non-partnered marital status has a significant positive association with prenatal depressive disorder, anxiety disorder and self-harm. This suggests it would be highly beneficial for maternal health care professionals to screen non-partnered pregnant women for prenatal mental health problems such as depression, anxiety and self-harm.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-05045-8.

Assessment of quality of life and psycho-emotional burden in pregnant women in Greece

INTRODUCTION

Many changes occur in a woman’s body during pregnancy. These changes (biological, chemical, hormonal, anatomical) can make a pregnant woman both physically and mentally vulnerable. Thus, the aim of this study is to evaluate the quality of life (QoL) in association with depression symptoms in pregnancy.

METHODS

A cross-sectional study was conducted in 123 pregnant women who visited one of the largest obstetrics and gynecology centers in Greece. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure depression symptoms and World Health Organization Quality of Life instrument to evaluate quality of life. The collected data were organized with the SPSS software, version 25.

RESULTS

The results showed that 15.5% of pregnant women were at an increased risk of developing depression symptoms; 91% of the women declared that their QoL was good/very good, whereas 92.7% was very satisfied with their health status. Depression symptoms seem to be positively correlated with the low household income, unpleasant event during pregnancy, and the trimester of pregnancy. Additionally, unmarried women, an unpleasant event during pregnancy and the second trimester of pregnancy proved to be negatively associated with the quality of life. Women without a risk of depression had better QοL than women who were at risk of depression symptoms.

CONCLUSIONS

It is important to evaluate the QοL of women during pregnancy with the aim of good prenatal health. The organization of the necessary interventions for mothers’ health and their newborns are also of vital importance.

Associations between Pregnancy-Related Symptoms, Serum 25(OH)D, and Physical Quality of Life in Pregnant Women

Vitamin D deficiency has been associated with pregnancy-related symptoms including fatigue, poor sleep quality, and musculoskeletal pain. Pregnant Black and Hispanic women are more likely to have vitamin D deficiency compared with pregnant non-Hispanic White women. Data are limited on the association of vitamin D deficiency with quality of life (QOL) among pregnant women. This study examined the association of serum 25(OH)D and pregnancy-related symptoms with QOL among pregnant predominantly minority women. Using a cross-sectional design, 119 pregnant Black and Hispanic women completed surveys and had blood drawn for serum 25(OH)D levels between 24–32 weeks gestation. Hierarchical regression analysis indicated that total pregnancy-related symptoms and serum 25(OH)D level were significant predictors of QOL, while controlling for covariates. Higher total pregnancy-related symptoms and lower serum 25(OH)D predicted poorer physical QOL. Screening for pregnancy-related symptoms and vitamin D levels among childbearing women might be important nursing interventions to improve physical QOL.

Trajectories of antenatal depression and adverse pregnancy outcomes

BACKGROUND

Antenatal depression affects approximately 1 of 7 pregnancies, with an increasing prevalence across gestation. Data regarding the associations between antenatal depression and adverse pregnancy outcomes yielded conflicting results. However, previous studies evaluated the cross-sectional prevalence of depression at various time points and not the depressive symptom trajectory across gestation.

OBJECTIVE

This study aimed to identify whether the trajectory of antenatal depressive symptoms is associated with different risks of adverse pregnancy outcomes.

STUDY DESIGN

This was a secondary analysis of a large multisite prospective cohort of nulliparous women across the United States. The Edinburgh Postpartum Depression Scale was administered at 2 study visits: between 6 and 14 weeks' gestation and between 22 and 30 weeks' gestation. The Edinburgh Postpartum Depression Scale score trajectories were categorized as improved, stable, or worsened based on whether the scores changed by at least 1 standard deviation between the 2 visits. The frequencies of adverse pregnancy outcomes (hypertensive disorders of pregnancy, abruption, cesarean delivery, preterm birth [ie, <37 weeks' gestation], small for gestational age neonates, neonatal intensive care unit admission, and maternal readmission) were compared with depression trajectories across gestation in bivariable and multivariable analyses. Secondary analyses evaluated the frequencies of spontaneous and medically indicated preterm births and frequencies of spontaneous and medically indicated preterm births before 35, 32, and 28 weeks' gestation.

RESULTS

Of the 8784 women who completed the 2 antenatal Edinburgh Postpartum Depression Scale screens, 1141 (13.0%) had improved, 6663 (75.9%) had stable, and 980 (11.2%) had worsened depressive symptom trajectories across gestation. Compared with women with improved or stable depressive symptoms, those with worsened symptoms were more likely to experience preterm birth (8.3% vs 7.4% vs 9.9%, respectively; P=.018). After controlling for potential confounders, worsened depressive symptoms remained associated with more frequent preterm birth (adjusted odds ratio, 1.68; 95% confidence interval, 1.10-2.57).

CONCLUSION

Women with depression symptoms that worsen as pregnancy progresses have increased odds of preterm birth. Future research is warranted to optimize and implement effective prevention, screening, and treatment protocols for antenatal depressive symptoms as a strategy to prevent preterm birth.

Associations of objectively measured physical activity and sedentary time with pregnancy-specific health-related quality of life

PURPOSE

To examine associations of objectively measured moderate-to-vigorous-intensity physical activity (MVPA) and sedentary behavior (SED) with pregnancy-specific health-related quality of life (QoL) across pregnancy trimesters.

MATERIALS AND METHODS

Women (N=131, mean age 30.9 years ± 4.9) were recruited from two large health care systems in the United States. MVPA and SED were estimated using a waist-worn ActiGraph GT3X and thigh-worn activPAL3 micro, respectively, for seven days in each trimester of pregnancy. Questionnaires were administered in each trimester to assess pregnancy-specific health-related QoL using the Nausea and Vomiting of Pregnancy Specific health Related Quality of Life (NVPQoL) questionnaire. Mixed effects linear regression examined associations of MVPA and SED with the NVPQoL total score and domain-specific scores (physical symptoms, fatigue, emotions, and limitations) across trimesters.

RESULTS

The NVPQoL total score and domain-specific scores significantly varied across trimesters, with highest scores (indicating worse QoL) observed in the first trimester and lowest scores (indicating better QoL) in the second trimester. A 1-standard deviation (SD) increment in MVPA (16.0 min/day or 1.8%) was associated with better QoL as indicated by the lower NVPQoL total score (β=-4.06, p=0.024) and limitations score (β = -2.80, p<0.001). A 1-SD increment in SED (1.5 hr/day or 10.0%) was associated with worse QoL as indicated by the higher fatigue score (β = 0.82, p=0.041).

CONCLUSIONS

Pregnancy-specific health-related QoL varies across trimesters. Both lower SED, and to a greater extent higher MVPA are potential behavioral targets for improving pregnancy-specific health-related QoL.

Quality of Life in Mothers With Perinatal Depression: A Systematic Review and Meta-Analysis

BACKGROUND

The prevalence of perinatal depression is high and its adverse effects on mothers and infants are extensive. Several studies have explored the relationship between perinatal depression and health-related quality of life (HRQoL), but little is known about the nature and magnitude of this effect. The objectives of this study were to evaluate the HRQoL of mothers with perinatal depression and compare the HRQoL of depressed mothers with that of non-depressed mothers.

METHODS

A systematic review was performed according to the PRISMA guidelines. PubMed, EMBASE, Scopus, PsycINFO, Web of Science, Cochrane Central Register, the China National Knowledge Infrastructure, the VIP Database, and the Wan Fang Database were searched. The retrieval time was from the establishment of the database to July 2020. A series of meta-analyses were run for each outcome pertaining to HRQoL sub-measures. Subgroup analyses were conducted based on country income category and time period.

RESULTS

Of 7,945 studies identified, 12 articles were included in the meta-analysis, providing HRQoL data for 4,392 mothers. Compared with non-depressed mothers, mothers with perinatal depression reported significantly poor scores across all the quality-of-life domains. Mixed-effects analysis showed that there was no difference in the HRQoL scores of mothers with antepartum and postpartum depression. Mothers with perinatal depression in higher-income countries reported higher disability on role-physical (p = 0.02) and social functioning domains (p = 0.001) than those from lower-income countries.

LIMITATIONS

Due to insufficient data, no regression analysis was performed. The inability to accurately determine the difference in HRQoL between antepartum and postpartum depression was because of the restriction of the included studies. Moreover, most of the included studies were conducted in middle-income countries and may have an impact on the applicability of the results. Subgroup analyses are observational and not based on random comparisons. The results of subgroup analyses should be interpreted with caution.

CONCLUSION

HRQoL is compromised in mothers with perinatal depression. Continuous efforts are required to improve the HRQoL of perinatal depressed mothers.Systematic Review Registration: CRD42020199488.

Bidirectional relationship between physical health symptoms and depressive symptoms in the pre- and postpartum period

OBJECTIVE

To test the bidirectional relationships between physical health symptoms (PHS) and depressive symptoms (DS) as well as between the intensity of 'any pain' and DS in the pre- and postpartum period METHOD: Women (N = 615) completed the Edinburgh Postnatal Depression Scale, the Patients Health Questionnaire-15, and numerical pain rating scales when they were between 32 and 37 weeks of gestation, and subsequently one, three, and six months postpartum. We conducted two random intercept cross-lagged panel models (RI-CLPM) RESULTS: Both models presented excellent fits. The relationship between PHS and DS was bidirectional across all the data waves (χ²(9) = 6.610, p = .678, CFI = 1, TLI = 1, RMSEA = 0). The magnitude of the standardized cross-lagged regression coefficient was relatively similar from DS to PHS (raging between 0.081 and 0.171); and from PHS to DS (raging between 0.121 and 0.138). The relationship between 'any pain' intensity and DS was also bidirectional, but only during the postnatal period (χ²(9) =11.765, p = .227, CFI = 0.99, TLI = 0.98, RMSEA = 0.022). The magnitude of the standardized cross-lagged regression coefficient was higher from DS to 'any pain' intensity (raging between 0.214 and 0.216); than from 'any pain' intensity to DS (raging between 0.092 and 0.097).

CONCLUSIONS

Concurrently intervening over physical and mental health symptoms could promote women's perinatal health.

Associated factors of pregnancy spacing among women of reproductive age Group in South of Iran: cross-sectional study

Background

Optimal pregnancy spacing is an important incidence in reproductive women’s health. Short or long pregnancy spacing leads to the greatest health, social and economic problems such as increase in maternal and infant mortality and morbidity, and adverse pregnancy outcomes. The aim of this study is to assess the mean of pregnancy spacing and associated factors of pregnancy spacing among women of reproductive age group with recurrent event analysis.

Methods

The fertility history of 1350 women aged 15–49 years was collected in this cross-sectional study. The women were selected through multistage random sampling method from a list of clinics in 2018. Some predictors were collected from their records and others were collected by face-to-face interview. The recurrent event survival analysis was used to explore the effect of predictors on pregnancy spacing. The R software program was used for analysis.

Results

There were nine predictors that had significant effect on pregnancy spacing. These predictors included the age of mother at marriage, mother’s BMI, contraception use, breast feeding duration of the previous child, the education level of husband, the sex preference of the mother, presence of abortion or stillbirth in the preceding pregnancies, income sufficiency, and mother’s awareness of optimum pregnancy interval. The most influential predictors; contraception use (HR = 2.34, 95%CI = 1.23 to 2.76, P < 0.001) and income sufficiency (HR = 2.046, 95%CI = 1.61 to 3.02, P = 0.018) lead to longer and son preference of mother (HR = 2.231, 95%CI = 1.24 to 2.81, P = 0.023) lead to shorter pregnancy spacing.

Conclusion

The up to date contraception tool should be at hand for couples to manage their pregnancy intervals. The unfavorable economic situation of a family leads to long pregnancy spacing. Despite the relative equality of the status of girls and boys in today’s societies, the desire to have a son child is still an important factor in shorter pregnancy spacing. The benefit of optimal pregnancy spacing should be more announced.

The effects of nausea, vomiting, and social support on health-related quality of life during early pregnancy: A prospective cohort study

OBJECTIVE

To date, no previous study has examined the independent association between nausea, vomiting, and social support and health-related quality of life among early pregnant women.

METHODS

To fill this gap, we investigated these associations within this group using repeated-measurement data.

METHODS

A prospective cohort design was conducted from August 2018 to February 2019 with perinatal outpatients in a general hospital. Participants were 153 pregnant women aged 20 years or older and under 20 weeks of gestation at their first prenatal visit. Along with reporting their sociodemographic data, participants completed the Index of Nausea, Vomiting, and Retching (INVR), the 12-item Short Form Health Survey (SF-12), and the Multidimensional Scale of Perceived Social Support (MSPSS) and re-completed INVR, and SF-12 at follow-up checkups a maximum of three times.

RESULTS

After controlling for internal correlations and confounding factors, INVR was found to be significantly negatively associated with the physical component summary scale score of SF-12; however, MSPSS showed no association with the physical component summary scale score. Conversely, the scores for both INVR and MSPSS were negatively and positively, respectively, significantly associated with the mental component summary scale score of SF-12.

CONCLUSION

The severity of nausea and vomiting significantly impacts physical quality of life during early pregnancy. Both nausea and vomiting and social support significantly and independently affect mental quality of life. Health professionals should recognize these impacts and be aware that social support contributes to improving mental quality of life.

Association between Stress Urinary Incontinence and Depressive Symptoms after Birth: the Czech ELSPAC Study

The study objectives were to (1) identify risk factors related to stress urinary incontinence (SUI) and postnatal depression (PD) after birth, and (2) investigate both possible directions of association between SUI and PD in population-based sample of Czech mothers. 3,701 nulliparous and multiparous women completed the self-reported questionnaires at 6 weeks and 6 months after birth and were included into the analyses of this prospective cohort study. Unadjusted and adjusted logistic regressions examined relationship between SUI a PD accounting for range of other risk factors. During the first 6 months after birth, 650 mothers (17.6%) developed SUI and 641 (17.3%) displayed signs of PD. The mode of delivery, parity and higher BMI were associated with SUI. The rate of PD symptoms was higher in mothers with positive history of prenatal depression, and in divorced or widowed mothers. Both conditions were associated with worse self-reported health, back pain and stop-smoker status. Initially, SUI at 6 weeks was slightly, but significantly associated with onset of PD at 6 months (OR 1.51, 95% CI 1.02–2.23) while PD at 6 weeks was not significantly related to new cases of SUI at 6 months (OR 1.48, 95% CI 0.91–2.39). After full adjustment these OR reduced to 1.41 and 1.38 (both non-significant), respectively. SUI and PD are common conditions in women postpartum that share some risk factors. Our study suggests that both directions of their relationship are possible although a larger study is needed to confirm our findings.

Assessment of childbirth preparation classes: a parallel convergent mixed study

Background

Women’s fear from childbirth has been associated with increased medical interventions and traumatized birth experience. Although antenatal education is a crucial factor to empower and prepare women for their birth journey, it is not clear how Iranian childbirth classes can influence women’s fear and prepare them positively towards childbirth. This research is designed to evaluate childbirth preparation classes and their impact on women’s perception on their childbirth experiences.

Methods/design

This mixed method study with the parallel convergent design has two phases. The first phase will be a quantitative cohort study with 204 primiparous pregnant women at the gestational age of 35–37 weeks. The participants will be divided into three groups based on the number of their attendance into the childbirth preparation classes: a) regular participation (4 to 8 sessions), b) irregular participation (1 to 3 sessions), and c) no-participation. Participant will be followed-up to 1 month after birth. Antenatal data will be collected by using a demographic survey questionnaire, the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ, version A), the Van den Bergh Pregnancy-Related Anxiety Questionnaire, the Satisfaction with Childbirth Preparation Classes Questionnaire, the Edinburgh Postpartum Depression Scale (EPDS) and Knowledge regarding pregnancy and childbirth Questionnaire. Postnatal data will be collected by using an Obstetric and Labor Characteristics Questionnaire, EPDS, and Childbirth experience questionnaire (CEQ). The quantitative data will be analyzed using one-way ANOVA and the multivariate linear regression. The second phase of the study will be a qualitative study that will explore the women’s perceptions on the impact of participation in childbirth preparation classes on their childbirth experience. The sampling in this phase will be purposeful and the participants will be studied individually by using in-depth, semi-structured interviews. The qualitative data will be analyzed through content analysis with conventional approach.

Discussion

Assessing the impact of childbirth preparation classes on women’s childbirth experience in Iran will lead to developing recommendations about the content and quality of the childbirth classes that can improve women’s’ preparation towards positive childbirth.

Associations Between ADHD Symptoms and Occupational, Interpersonal, and Daily Life Impairments Among Pregnant Women

OBJECTIVE

Past research links symptoms of depression and anxiety with functional impairments among pregnant women. However, no prior research has examined the impact of ADHD symptoms among this population. The current study examines associations between ADHD symptoms and impairment in several life domains.

METHOD

Self-report measures of ADHD symptoms, impairment, and demographic information were collected from 250 pregnant women at an urban women's health clinic in the Southeast. Data were assessed using multivariate path analysis.

RESULTS

Inattentive symptoms were significant predictors of professional life impairment, daily life impairment, and relationship impairment. Impulsivity uniquely predicted variability in professional life impairment and relationship impairment. Hyperactivity was not a significant predictor.

CONCLUSION

Future research should focus on the mechanisms by which inattention and impulsivity affect daily functioning in pregnant women, in addition to investigating potential interventions. Health care professionals should assess for impulsivity and inattention among pregnant women.

Health-related quality of life in pregnancy with uterine fibroid: a cross-sectional study in China

Background

Uterine fibroids (UFs) are the most common benign tumors in women. They are likely to cause numerous clinical symptoms, such as pain, menorrhagia, and other obstetric complications in pregnant women. This study aimed to determine the health-related quality of life (HRQoL) during pregnancy with uterine fibroids (UF), thus providing a utility-based case value in pregnant women with UF and understanding of whether HRQoL is associated with clinical outcomes in pregnant women with UFs.

Method

This study was conducted in a cross-sectional manner. This study was based on questionnaire surveys completed by sequential out- and in-patients and was conducted in a regional university hospital in Guangzhou, China. The EuroQoL five-dimension-five-level (EQ-5D-5 L) questionnaire was used, and demographic data were collected. An electronic record of the clinical outcomes of pregnant women with UF was retrieved from the hospital’s electronic medical record system. The association between UF and HRQoL was evaluated by ordered regression.

Results

Seven-hundred-sixty-seven pregnant women with a mean age (SD) of 32.7 (4.8) years completed 707 questionnaires. Overall, when comparing the UF with non-UF groups, we detected statistical differences in age, body mass index (BMI), gravidity and abortion times, partner’s smoking and alcoholic habits, advanced maternal age, and uterine scars (p <  0.05). Furthermore, pregnant women without UF scored significantly higher than those with UF on the EQ-5D value system (0.84 versus 0.79; p = 0.017). Moreover, pregnant women with UF suffered more health-related problems, especially with respect to self-care (odds ratio [OR] = 3.69, p <  0.01) and usual activity dimensions (OR = 2.11; p = 0.01).

Conclusion

We found that UF has a negative impact on the HRQoL of pregnant women with respect to self-care and usual activity dimensions. Also, the EQ-5D score was a better index than the EQ-VAS score for HRQoL when evaluating of the QoL of our population of pregnant women.

Factors influencing the quality of life of pregnant women: a systematic review

Background

Pregnancy is a period of transition with important physical and emotional changes. Even in uncomplicated pregnancies, these changes can affect the quality of life (QOL) of pregnant women, affecting both maternal and infant health. The objectives of this study were to describe the quality of life during uncomplicated pregnancy and to assess its associated socio-demographic, physical and psychological factors in developed countries.

Methods

A systematic review was performed according to the PRISMA guidelines. Searches were made in PubMed, EMBASE and BDSP (Public Health Database). Two independent reviewers extracted the data. Countries with a human development index over 0.7 were selected. The quality of the articles was evaluated on the basis of the STROBE criteria.

Results

In total, thirty-seven articles were included. While the physical component of QOL decreased throughout pregnancy, the mental component was stable and even showed an improvement during pregnancy. Main factors associated with better QOL were mean maternal age, primiparity, early gestational age, the absence of social and economic problems, having family and friends, doing physical exercise, feeling happiness at being pregnant and being optimistic. Main factors associated with poorer QOL were medically assisted reproduction, complications before or during pregnancy, obesity, nausea and vomiting, epigastralgia, back pain, smoking during the months prior to conception, a history of alcohol dependence, sleep difficulties, stress, anxiety, depression during pregnancy and sexual or domestic violence.

Conclusions

Health-related quality of life refers to the subjective assessment of patients regarding the physical, mental and social dimensions of well-being. Improving the quality of life of pregnant women requires better identification of their difficulties and guidance which offers assistance whenever possible.

Explanatory factors and levels of health-related quality of life among healthy pregnant women at midpregnancy: A cross-sectional study of The PregnActive Project

AIMS

To identify potential explanatory factors and establish health-related quality of life (HRQoL) levels of healthy pregnant women at midpregnancy.

BACKGROUND

The HRQoL levels perceived by pregnant women are lower than those perceived by women of similar age and decline during the course of pregnancy.

DESIGN

An exploratory cross-sectional design was used.

METHODS

One hundred thirty-four healthy women from antenatal clinics completed questionnaires were administered a cardiorespiratory fitness (CRF) test and wore a multisensor body monitor for 7 days at midpregnancy. Data were collected from September 2015-December 2016.

RESULTS

Cardiorespiratory fitness, musculoskeletal symptoms, and age were identified as explanatory factors of the physical component summary of HRQoL. Explanatory factors of the mental component summary included musculoskeletal and psychological symptoms and light activity. Significant differences in HRQoL levels were identified among groups of pregnant women stratified by age, occupational status, pregnancy symptoms, and CRF.

CONCLUSIONS

Modifiable factors of HRQoL, such as CRF and active lifestyle may be important areas to target in interventions aimed at promoting HRQoL in healthy women at midpregnancy. The identification of the groups of pregnant women with lower levels of HRQoL may help midwives and health professional to focus their advice and conduct interventions on these groups of pregnant women. These modifiable factors should be considered in future longitudinal studies to determine causal effects, will likely help improve multidisciplinary treatments.

Turkish adaptation of the pregnancy-related anxiety questionnaire-revised 2: Validity and reliability study in multiparous and primiparous pregnancy

OBJECTIVE

The purpose of this study was to create a Turkish version of the Pregnancy-Related Anxiety Questionnaire-Revised 2 (PRAQR2), which was revised for application to multiparous and primiparous pregnancy, and to explore its psychometric characteristics in multiparous and primiparous pregnancy.

DESIGN

This study was methodologically designed to assess the reliability and validity of the PRAQ-R2.

SETTING

The study was carried out in the obstetrics clinic of a training and research hospital in Malatya.

PARTICIPANTS

A total of 616 healthy pregnant women (399 multiparous and 217 primiparous) constituted the sample of the study.

METHODS

The cultural adaptation process of the questionnaire was conducted in three phases: language validity, content validity, and pilot application. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to test the construct validity of the questionnaire. The reliability of the PRAQ-R2 was evaluated with Cronbach's alpha internal consistency coefficient, item-total correlation, test-retest analysis, and parallel forms reliability.

FINDINGS

The EFA revealed that the PRAQ-R2 consists of 10 items for the multiparous group and 11 for the primiparous group after adding the item ``I am anxious about the delivery because I have never experienced one before.'' The CFA for both groups supported the three-factor questionnaire yielded by the EFA. Good fit index values were obtained in both groups. Cronbach's alpha internal consistency coefficient ranged from 0.81 to 0.93 for the multiparous group and 0.87 to 0.94 for the primiparous group for the complete PRAQ-R2 and each of its subdimensions. In addition, the item-total correlation, test-retest analysis, and parallel forms reliability of the questionnaire were highly correlated.

CONCLUSION

The PRAQ-R2 is a valid and reliable instrument that can be used to evaluate the level of anxiety in Turkish pregnant women irrespective of parity.

IMPLICATIONS FOR PRACTICE

The use of the PRAQ-R2 in prenatal healthcare services will contribute to the early diagnosis, treatment, and management of pregnancy-related anxiety.

Effects of Support Interventions in Women Hospitalized With Preterm Labor

This study was to examine the effects of support interventions on anxiety, depression, and quality of life in women hospitalized with preterm labor. A randomized, single-blind experimental design was used. Participants were recruited from maternity wards of one medical center in Taiwan. The control group ( n = 103) received routine nursing care, and intervention group ( n = 140) received interventional support during hospitalization. The Beck Anxiety Inventory, Edinburgh Postnatal Depression Scale, and Quality of Life Enjoyment and Satisfaction Questionnaire were used at admission and 2 weeks of hospitalization. For the control group, anxiety and depression scores increased significantly and quality of life decreased 2 weeks after hospitalization. Participants who received 2 weeks of support intervention had significantly lower anxiety and depression scores than controls. Thus, clinical nurses can offer support interventions to improve anxiety and depression for women with preterm labor during hospitalization.

Trajectories of anxiety and health related quality of life during pregnancy

Anxiety and health related Quality of Life (HRQoL) have emerged as important mental health measures in obstetric care. Few studies have systematically examined the longitudinal trajectories of anxiety and HRQoL in pregnancy. Using a linear growth modeling strategy, we analyzed the course of State-Trait Anxiety Inventory (STAI)- and Short Form (36) Health Survey (SF-36) scores between the 12th and the 36th week of gestation, in a sample of 355 women. We additionally analyzed the impact of depressive symptoms and a chronic medical condition (asthma), on STAI and SF-36 trajectory curves. STAI scores remained stable throughout pregnancy. A previous history of anxiety increased the overall STAI scores. Asthma and depressive symptoms scores had no impact on the STAI trajectory. Physical SF-36 scores decreased over the course of pregnancy, whereas mental SF-36 trended towards improvement. Asthma reduced physical SF-36 overall. While high depressive symptoms decreased the overall mental SF-36, they were also significantly associated with mental SF-36 improvements over time. Anxiety symptoms are stable during pregnancy and are not modulated by depressive symptoms or asthma. Physical HRQoL declines in pregnancy. In contrast, mental HRQoL appears to improve, particularly in women with high initial levels of depressive symptoms.

"The Burden of Pregnancy"; heavier for the heaviest? The changes in Health Related Quality of Life (HRQoL) assessed by the 15D instrument during pregnancy and postpartum in different body mass index groups: a longitudinal survey

INTRODUCTION

Only little information is available on health-related quality of life (HRQoL) and its changes during the course of a normal pregnancy. We studied changes in HRQoL in a pregnant population during pregnancy and until 1 year postpartum in different body mass index (BMI) groups.

MATERIAL AND METHODS

Seven hundred and fifty pregnant women attending the first ultrasound examination before gestational week 14 were invited to participate in a longitudinal, communal-based survey. The participants were divided into three groups according to their BMI; <25, 25-29.9, and ≥30 kg/m² . The women were asked to fill in questionnaires assessing HRQoL (15D), depressive symptoms (Edinburgh Depression Scale, EPDS), medical, obstetric and socioeconomic status at baseline. HRQoL and EPDS were re-assessed at 30 weeks of gestation, and 6 weeks, 3 and 12 months postpartum.

RESULTS

Of the invited 750 mothers, 325 (43%) returned the questionnaires and at least one follow-up questionnaire. At baseline, mean 15D scores decreased with increasing BMI but the difference was not statistically significant when adjusted for age, educational attainment, parity or EPDS-scores (0.929, 0.921 and 0.916, p = 0.16). During the course of pregnancy, the HRQoL of all women decreased but this decrease was significantly greater in the obese group (-0.088; 95% CI -0.110 to -0.065) than in the other groups [-0.054 (95% CI -0.062 to -0.045) and -0.051 (95% CI -0.068 to -0.033), p = 0.019]. Within 3 months postpartum the mean HRQoL recovered in all BMI groups to baseline levels, irrespective of the mode of delivery or pregnancy-related complications.

CONCLUSION

The burden of pregnancy is heavier for the heaviest.

Influence of Fatigue, Depression and Anxiety on Quality of Life in Pregnant Women with Preterm Labor

PURPOSE

The purpose of this study was to identify effects of fatigue, depression and anxiety on quality of life in pregnant women with preterm labor.

METHODS

With a survey design, data were collected from 138 mothers who were admitted at a hospital in Seoul, between June 2014 and September 2015. Instruments used to collect the data for the study were: Fatigue Continuum Form, Depression anxiety stress scale (DASS-21) and maternal postpartum quality of life (MAPP-QOL).

RESULTS

The mean fatigue score was 68.30 with 50.7% of women being depressed and 79.7% of the 138 women being anxious. The mean quality of life was 18.92 with quality of life being associated with fatigue, depression and anxiety. Depression and fatigue explained 26% of the variance in quality of life.

CONCLUSION

Depression and fatigue adversely affected women's quality of life. It is important to address appropriate management of depression and fatigue in order to improve quality of life in pregnant women with preterm labor.

Measures of Maternal Stress and Mood in Relation to Preterm Birth

OBJECTIVE

To investigate the relationships between psychological and physiologic measures of stress, mood, and gestational age at delivery and preterm birth.

METHODS

This prospective cohort study recruited healthy women in the early second trimester who were 18-45 years of age. Validated psychological measures of perceived stress, depressive symptoms, and anxiety were completed at 16, 22, 28, 34, and 40 weeks of gestation. Cortisol concentration was measured in maternal hair at 16, 28, and 40 weeks of gestation to approximate first-, second-, and third-trimester levels of physiologic stress. Statistical methods included: analyses of variance, t tests, χ, Pearson correlations, regression modeling, and mediation analysis as appropriate. Hair cortisol concentrations were natural log-transformed to normalize values.

RESULTS

Eleven (12%) of the 90 included women had a spontaneous preterm birth or preterm premature rupture of membranes. Perceived stress at 16 weeks of gestation correlated with both second-trimester cortisol concentration (r=0.28, P=.007) and earlier gestational age at delivery (r=-0.30, P<.01). Gestational age at delivery was also negatively correlated with cortisol concentration in the second trimester (r=-0.25, P=.02) and second-trimester cortisol concentration was higher in preterm- (2.7 ± 0.4 log-transformed pg/mg) compared with term- (2.0 ± 0.7 log-transformed pg/mg, P<.001) delivered women. Using mediation statistics, the association between the psychological measure, the physiologic measure, and gestational age at delivery was mainly driven by increased physiologic stress (hair cortisol concentration) in the second trimester (difference in coefficients [standard error]=-0.05 [0.02]).

CONCLUSION

Higher perceived stress in the second trimester is associated with both elevated second-trimester hair cortisol concentration and gestational age at delivery. Physiologic measure of stress in the second trimester appears most strongly associated with preterm birth. Identification and amelioration of early pregnancy stressors may attenuate physiologic stress and ultimately affect preterm birth.

Modelling the distribution of health-related quality of life of advanced melanoma patients in a longitudinal multi-centre clinical trial using M-quantile random effects regression

Health-related quality of life assessment is important in the clinical evaluation of patients with metastatic disease that may offer useful information in understanding the clinical effectiveness of a treatment. To assess if a set of explicative variables impacts on the health-related quality of life, regression models are routinely adopted. However, the interest of researchers may be focussed on modelling other parts (e.g. quantiles) of this conditional distribution. In this paper, we present an approach based on quantile and M-quantile regression to achieve this goal. We applied the methodologies to a prospective, randomized, multi-centre clinical trial. In order to take into account the hierarchical nature of the data we extended the M-quantile regression model to a three-level random effects specification and estimated it by maximum likelihood.

Prenatal Depressive Symptoms and Postpartum Sexual Risk Among Young Urban Women of Color

STUDY OBJECTIVE

To determine whether prenatal depressive symptoms are associated with postpartum sexual risk among young, urban women of color.

DESIGN

Participants completed surveys during their second trimester of pregnancy and at 1 year postpartum. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression Scale, excluding somatic items because women were pregnant. Logistic and linear regression models adjusted for known predictors of sexual risk and baseline outcome variables were used to assess whether prenatal depressive symptoms make an independent contribution to sexual risk over time.

SETTING

Fourteen community health centers and hospitals in New York City.

PARTICIPANTS

The participants included 757 predominantly black and Latina (91%, n = 692) pregnant teens and young women aged 14-21 years.

INTERVENTIONS AND MAIN OUTCOME MEASURES

The main outcome measures were number of sex partners, condom use, exposure to high-risk sex partners, diagnosis of a sexually transmitted disease, and repeat pregnancy.

RESULTS

High levels of prenatal depressive symptoms were significantly associated with increased number of sex partners (β = 0.17; standard error, 0.08), decreased condom use (β = -7.16; standard error, 3.08), and greater likelihood of having had sex with a high-risk partner (odds ratio = 1.84; 95% confidence interval, 1.26-2.70), and repeat pregnancy (odds ratio = 1.72; 95% confidence interval, 1.09-2.72), among participants who were sexually active (all P < .05). Prenatal depressive symptoms were not associated with whether participants engaged in postpartum sexual activity or sexually transmitted disease incidence.

CONCLUSION

Screening and treatment for depression should be available routinely to women at risk for antenatal depression.

The effect of progressive muscle relaxation on pregnant women's general health

Background:

Pregnancy may be accompanied by serious physiological and psychological changes as it is a stressful period in a woman's life. So, this study was conducted to determine the effect of progressive muscle relaxation on pregnant women's general health.

Materials and Methods:

In this clinical trial, 60 primigravida women admitted to the prenatal clinic of selected hospitals in Iran constituted the study population. Using purposive sampling method, the level of general health of the women was measured with General Health Questionnaire-28 (GHQ-28). Then, the samples were randomly divided into control and experimental groups. Three 1.5–2 h relaxation training sessions were held for the experimental group. After 8 weeks, the level of general health of both groups was measured again. Finally, the collected data were analyzed using Chi-square and paired t-test (P < 0.05).

Results:

Total mean score of general health of the experimental group and the control group before the intervention was 35.83 (6.92) and 29.46 (8.3), respectively, and after the intervention, the respective scores were 20.2 (5.61) and 27.85 (8.24). Although after the intervention both groups showed an increased level of general health, the difference in general health between before and after intervention was significant in the experimental group (P < 0.001). Furthermore, comparison of variations in mean scores of general health level before and after intervention in the two groups showed a significant difference (P < 0.001).

Conclusions:

Given that the results showed the effectiveness of progressive muscle relaxation on pregnant women's general health, the prenatal clinics can include a training program for progressive muscle relaxation in the routine training programs for pregnant women.

Sleep Quality and Health-Related Quality of Life in Pregnancy

The aim of this study was to investigate sleep quality and health-related quality of life in pregnancy. In a cross-sectional design, 492 women (292 pregnant and 200 nonpregnant healthy controls) were included in this study between November 2014 and June 2015. Participants completed a survey on sociodemographic characteristics, the Pittsburgh Sleep Quality Index (PSQI), and the European Quality of Life-5 Dimensions (EQ-5D). The PSQI total and EQ-5D scores of pregnant women were significantly worse than the controls (P = .017 and P < .001, respectively). Linear regression analysis showed that only pregnancy status was related to PSQI scores (β = .117; P = .009). Compared with the first trimester, the risk of poor sleep quality increased 2.11-fold in the second trimester (P = .048) and 1.86-fold in the third trimester (P = .054). Compared with the first trimester, EQ-5D scores significantly decreased in the second (P = .038) and third (P < .001) trimesters. Sleep quality and health-related quality of life of pregnant women were worse than those of nonpregnant healthy controls. Healthcare professionals need to be aware of deteriorations in sleep quality and health-related quality of life of pregnant women.

Adaption of pregnancy anxiety questionnaire-revised for all pregnant women regardless of parity: PRAQ-R2

The 10-item Pregnancy-Related Anxiety Questionnaire-Revised (PRAQ-R) is a widely used instrument to assess and identify pregnancy-specific anxiety in nulliparous women. It has good psychometric values and predictive validity for birth and childhood outcomes. Nonetheless, the PRAQ-R is not designed for use in parous women, as particularly one item of the questionnaire is not relevant for women who gave birth before. We tested the factorial and scalar invariance of a modified PRAQ-R2 across nulliparous and parous women with an adapted item to fit both groups of pregnant women. A longitudinal study among 1144 pregnant women (n = 608 nulliparous and n = 536 parous) with two repeated measures of the PRAQ-R2 was used to test for measurement invariance of the instrument. Results show metric and scalar invariance, indicating that the PRAQ-R2 measures similar constructs on the same scale for all pregnant women at two different times during pregnancy. We conclude that the PRAQ-R2 can be used, compared, or combined in a sample of nulliparous and parous women.

Cannabis use and mental health-related quality of life among individuals with depressive disorders

Cannabis is the most widely used illicit substance among individuals with depressive disorders. This study aimed to evaluate whether among individuals with depressive disorders, higher frequency of cannabis use would be associated with poorer Quality of Life (QoL), based on a large nationally representative US sample. Individuals with depressive disorders (N=3416) were divided into categories according to no use (N=3096), occasional use (less than weekly, N=176) and regular (at least weekly, N=144) use of cannabis in the past 12 months. QoL was assessed using the Short-Form 12 (SF-12) questionnaire. Women who used cannabis regularly had a significantly lower SF-12 Mental Component Summary score (MCS) compared to non-users, with a mean difference of 0.4 Standard Deviations (SDs). Comparison of subscale scores showed no significant differences. No significant difference was noted when comparing women who used cannabis occasionally to non-users. No differences were found among men when comparing MCS and mental subscale scores of both regular and occasional users to non-users. Our findings highlight the importance of taking gender and the frequency of cannabis use into account, when assessing functional and emotional aspects of cannabis use among individuals with depressive disorders.

Association between probable postnatal depression and increased infant mortality and morbidity: findings from the DON population-based cohort study in rural Ghana

OBJECTIVES

To assess the impact of probable depression in the immediate postnatal period on subsequent infant mortality and morbidity.

DESIGN

Cohort study nested within 4 weekly surveillance of all women of reproductive age to identify pregnancies and collect data on births and deaths.

SETTING

Rural/periurban communities within the Kintampo Health Research Centre study area of the Brong-Ahafo Region of Ghana.

PARTICIPANTS

16,560 mothers who had a live singleton birth reported between 24 March 2008 and 11 July 2009, who were screened for probable postnatal depression (pPND) between 4 and 12 weeks post partum (some of whom had also had depression assessed at pregnancy), and whose infants survived to this point.

PRIMARY/SECONDARY OUTCOME MEASURES

All-cause early infant mortality expressed per 1000 infant-months of follow-up from the time of postnatal assessment to 6 months of age. The secondary outcomes were (1) all-cause infant mortality from the time of postnatal assessment to 12 months of age and (2) reported infant morbidity from the time of the postnatal assessment to 12 months of age.

RESULTS

130 infant deaths were recorded and singletons were followed for 67,457.4 infant-months from the time of their mothers' postnatal depression assessment. pPND was associated with an almost threefold increased risk of mortality up to 6 months (adjusted rate ratio (RR), 2.86 (1.58 to 5.19); p=0.001). The RR up to 12 months was 1.88 (1.09 to 3.24; p=0.023). pPND was also associated with increased risk of infant morbidity.

CONCLUSIONS

There is new evidence for the association between maternal pPND and infant mortality in low-income and middle-income countries. Implementation of the WHO's Mental Health Gap Action Programme (mhGAP) to scale up packages of care integrated with maternal health is encouraged as an important adjunct to child survival efforts.

Determinants of postnatal depression in rural ghana: findings from the don population based cohort study

BACKGROUND

Risk factors for postnatal depression (PND), one of the most pervasive complications of child bearing, are poorly understood in Africa. A recent systematic review of 31 studies found that the strongest predictors are social and economic disadvantage and gender-based factors; only six of these studies were community based, and almost all were in South Asia.

METHODS

Cohort study nested within 4 weekly surveillance of all women of reproductive age to identify pregnancies and collect data on births and deaths in the Kintampo Health Research Centre study area of Ghana. Women were screened for depression during pregnancy and after birth using the Patient Health Questionnaire to ascertain DSM-IV major or minor depression. Information was collected on determinants relating to the mother, birth, and baby, which were examined using logistic regression; effect sizes reported as relative risks with 95% confidence intervals.

RESULTS

Thirteen thousand nine hundred and twenty nine women were screened both during pregnancy and after birth, of whom 13,360 (95.9%) had complete data on potential determinants. Two hundred and fifty five (3.8%, 95% CI: 3.5%, 4.1%) had PND. Antenatal depression (AND) was the strongest determinant accounting for 34.4% of PND cases. Other determinants were season of delivery, peripartum/postpartum complications, newborn ill health, still birth, or neonatal death. Common determinants were observed for onset and persistent depression.

CONCLUSIONS

Although most AND resolves in this setting, more than a third of women with PND also had AND. Adverse birth- and baby-related outcomes are the other main determinants. We recommend that programs detect and treat depression during pregnancy and provide support to women with adverse birth outcomes.

Association of antenatal depression with adverse consequences for the mother and newborn in rural Ghana: findings from the DON population-based cohort study

Background

Whilst there is compelling evidence of an almost 2-fold increased risk of still births, and suggestive evidence of increased mortality among offspring of mothers with psychotic disorders, only three studies have addressed the role of antenatal depression (AND) on survival of the baby. We examined these associations in a large cohort of pregnant women in Ghana.

Methods

A Cohort study nested within 4-weekly surveillance of all women of reproductive age to identify pregnancies and collect data on births and deaths in the Kintampo Health Research Centre study area of Ghana. Women were screened for AND using the Patient Health Questionnaire (PHQ-9) to ascertain DSM-IV major or minor depression. Outcomes were adverse birth outcomes, maternal/infant morbidity, and uptake of key newborn care practices, examined using logistic regression; effect sizes reported as relative risks with 95% confidence intervals.

Results

20679 (89.6%) pregnant women completed the PHQ-9. The prevalence of AND was 9.9% (n = 2032) (95% confidence interval 9.4%–10.2%). AND was associated with: prolonged labour (RR 1.25, 95% CI 1.02–1.53); peripartum complications (RR 1.11, 95% CI 1.07–1.15);postpartum complications (RR 1.27, 96% CI 1.21–1.34); non-vaginal delivery (RR 1.19, 95% CI 1.02–1.40); newborn illness (RR 1.52, 95% CI 1.16–1.99); and bed net use during pregnancy (RR 0.93, 95% CI 0.89–0.98), but not neonatal deaths, still births, low birth weight, immediate breast feeding initiation, or exclusive breastfeeding. AND was marginally associated with preterm births (RR 1.32, 95% CI 0.98–1.76).

Conclusion

This paper has contributed important evidence on the role of antenatal depression as a potential contributor to maternal and infant morbidity. Non-pharmacological treatments anchored on primary care delivery structures are recommended as an immediate step. We further recommend that trials are designed to assess if treating antenatal depression in conjunction with improving the quality of obstetric care results in improved maternal and newborn outcomes.

The interrelationship between pregnancy-specific anxiety and general anxiety across pregnancy: a longitudinal study

BACKGROUND

High levels of prenatal maternal anxiety - either pregnancy-specific anxiety or general anxiety - may have detrimental effects on both the mother and her child. It is currently unknown how these two different expressions of anxiety influence each other over time during pregnancy.

AIMS

This study aimed to describe the relationship between state, trait and pregnancy-specific anxiety levels across pregnancy.

METHODS

Longitudinal data from three data-waves of a large-scaled sample of nulliparous normal risk pregnant women were used to display associations over time by means of autoregressive and cross-lagged panel models.

RESULTS

Cross-lagged, cross-time pathways from pregnancy-specific anxiety to state as well as trait anxiety were positively significant, while vice versa the most consistent links were found from trait anxiety to pregnancy-specific anxiety.

CONCLUSIONS

We conclude that pregnancy-specific anxiety and general anxiety appear to influence each other over time, resulting in heightened anxiety for some soon-to-be mothers.

Effects of Progressive Muscle Relaxation Exercises Accompanied by Music on Low Back Pain and Quality of Life During Pregnancy

INTRODUCTION

Back pain is commonly experienced by pregnant women. Evidence suggests that progressive muscle relaxation (PMR) therapy, a complementary therapy widely used by pregnant women, may improve the physical and psychological outcomes of pregnancy. The aim of this study was to investigate the effects of PMR training accompanied by music on perceived pain and quality of life (QOL) in pregnant women with low back pain (LBP).

METHODS

This was a prospective randomized controlled trial. The study was designed to examine the effects of PMR accompanied by music on pregnant women with LBP. In total, 66 pregnant women were assigned randomly to a PMR group or a control group (33 women in each). A personal information form was used as a data collection tool; a visual analog scale was used for measuring pain; and the Short Form-36 was used to evaluate QOL.

RESULTS

The control and intervention groups were comparable at baseline. Significant differences were observed between the 2 groups after 4 and 8 weeks of intervention. The intervention group showed significant improvement in all QOL subscales after the intervention. The intervention group, but not the control group, showed significant improvement in perceived pain after the intervention. The intervention group experienced a greater decrease in perceived pain and improved QOL than the control group.

DISCUSSION

Our findings show that PMR accompanied by music may be an effective therapy for improving pain and QOL in pregnant women with LBP. Large randomized studies are recommended to confirm these results.

Perinatal psychiatric disorders: an overview

Perinatal mental illness has a significant implication on maternal health, birth outcomes, and the offspring's development. Prevalence estimates of perinatal psychiatric illnesses range widely, with substantial heterogeneity in different population studies, with a lower prevalence rate in high- rather than low- or middle-income countries. Because of the potential negative impact on maternal and child outcomes and the potential lability of these disorders, the perinatal period is a critical time to identify psychiatric illnesses. Thus, obstetricians and midwives play a crucial role in assessing women's mental health needs and to refer identified women promptly for multidisciplinary specialist assessment. However, there is still limited evidence on best practice assessment and management policies during pregnancy and postpartum. This review focuses on the prevalence of common perinatal mental disorders and antenatal screening policies to identify women at risk. The effect of these conditions and their management on pregnancy, fetal outcomes, and child development are discussed.

A repeated measures study of changes in health-related quality of life during pregnancy and the relationship with obstetric factors

AIMS

To examine changes in health-related quality of life throughout the course of pregnancy and among three pairs of consecutive periods (pre-pregnancy to early pregnancy, early to middle pregnancy and middle to late pregnancy), as well as to identify associated obstetric factors during the entire period of pregnancy.

BACKGROUND

Only sparse data are available concerning the profiles of health-related quality of life throughout pregnancy.

DESIGN

A within-subject comparison was undertaken.

METHODS

In total, 358 women completed the Taiwanese version of the Medical Outcomes Study Short Form-36 Health Questionnaire and a demographic-obstetric questionnaire at three stages of pregnancy at a medical centre. The participants were recruited between 2009-2010. A generalized estimating equation regression model was employed for the repeated measures.

RESULTS

The scores for physical component summary decreased significantly throughout early, middle and late pregnancy. The scores for mental component summary increased. The scores for physical, mental component summary and the eight domains of health-related quality of life decreased significantly from pre-pregnancy to early pregnancy. After adjusting for demographic and clinical factors, significant factors predicting physical component summary during pregnancy included stage of pregnancy and previous infertility. The factors predicting mental component summary included stage of pregnancy, parity and medical condition.

CONCLUSIONS

The results revealed the dynamic pattern of perceived health status by the Taiwanese pregnant women in their surrounding socio-cultural context and identified the stage of pregnancy and obstetric factors predicting health-related quality of life.