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Hsu HW, Huang JP, Au HK, Lin CL, Chen YY, Chien LC, Chao HJ, Lo YC, Lin WY, Chen YH. Impact of miscarriage and termination of pregnancy on subsequent pregnancies: A longitudinal study of maternal and paternal depression, anxiety and eudaimonia. J Affect Disord 2024; 354:544-552. [PMID: 38479500 DOI: 10.1016/j.jad.2024.03.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/27/2024] [Accepted: 03/09/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Although miscarriage and termination of pregnancy affect maternal mental illnesses on subsequent pregnancies, their effects on the positive mental health (e.g., eudaimonia) of both first-time and multi-time parents have received minimal attention, especially for fathers. This longitudinal study examines the effects of experiences of miscarriage and termination on parental well-being in subsequent pregnancies from prenatal to postpartum years, while simultaneously considering parity. METHODS Pregnant women and their partners were recruited during early prenatal visits in Taiwan from 2011 to 2022 and were followed up from mid-pregnancy to 1 year postpartum. Six waves of self-reported assessments were employed. RESULTS Of 1813 women, 11.3 % and 14.7 % had experiences of miscarriage and termination, respectively. Compared with the group without experiences of miscarriage or termination, experiences of miscarriage were associated with increased risks of paternal depression (adjusted odds ratio = 1.6, 95 % confidence interval [CI] = 1.13-2.27), higher levels of anxiety (adjusted β = 1.83, 95 % CI = 0.21-3.46), and lower eudaimonia scores (adjusted β = -1.09, 95 % CI = -1.99 to -0.19) from the prenatal to postpartum years, particularly among multiparous individuals. Additionally, experiences of termination were associated with increased risks of depression in their partner. LIMITATIONS The experiences of miscarriage and TOP were self-reported and limited in acquiring more detailed information through questioning. CONCLUSIONS These findings highlight the decreased well-being of men whose partners have undergone termination of pregnancy or experienced miscarriage, and stress the importance of interventions aimed at preventing adverse consequences among these individuals.
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Affiliation(s)
- Hsueh-Wen Hsu
- Master Program in Applied Epidemiology, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Jian-Pei Huang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Heng-Kien Au
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chen-Li Lin
- Department of Obstetrics & Gynecology, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan
| | - Yi-Yung Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ling-Chu Chien
- School of Public Health, College of Public Health, Taipei Medical University, New Taipei City, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
| | - Hsing Jasmine Chao
- School of Public Health, College of Public Health, Taipei Medical University, New Taipei City, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chun Lo
- Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan; Ph.D Program in Medical Neuroscience, College of Medical Science and Techonology, Taipei Medical University, New Taipei City, Taiwan
| | - Wen-Yi Lin
- Ph.D. Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, New Taipei City, Taiwan
| | - Yi-Hua Chen
- School of Public Health, College of Public Health, Taipei Medical University, New Taipei City, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan; Research Center of Health Equity, College of Public Health, Taipei Medical University, New Taipei City, Taiwan.
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Shen Q, Fu Q, Mao C. Network analysis of posttraumatic stress and posttraumatic growth symptoms among women in subsequent pregnancies following pregnancy loss. BMC Psychiatry 2024; 24:266. [PMID: 38594684 PMCID: PMC11003179 DOI: 10.1186/s12888-024-05702-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/21/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Pregnant women who have undergone pregnancy loss often display both posttraumatic stress (PTS) and posttraumatic growth (PTG). However, the precise relationship and structure of symptomatic levels of PTS and PTG have not been well understood. This study aimed to assess the associations between PTS and PTG symptoms in women during subsequent pregnancies following a previous pregnancy loss. METHODS A total of 406 pregnant women with a history of pregnancy loss were included in this study. The Impact of Events Scale-6 (IES-6) and the Posttraumatic Growth Inventory Short Form (PTGI-SF) were used to assess symptoms of PTS and PTG, respectively. The Graphical Gaussian Model was employed to estimate the network model. Central symptoms and bridge symptoms were identified based on "expected influence" and "bridge expected influence" indices, respectively. The stability and accuracy of the network were examined using the case-dropping procedure and nonparametric bootstrapped procedure. RESULTS The network analysis identified PTG3 ("Ability to do better things") as the most central symptom, followed by PTS3 ("Avoidance of thoughts") and PTG6 ("New path for life") in the sample. Additionally, PTS3 ("Avoidance of thoughts") and PTG9 ("Perception of greater personal strength") were bridge symptoms linking PTS and PTG clusters. The network structure was robust in stability and accuracy tests. CONCLUSIONS Interventions targeting the central symptoms identified, along with key bridge symptoms, have the potential to alleviate the severity of PTS experienced by women with a history of pregnancy loss and promote their personal growth.
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Affiliation(s)
- Qiaoqiao Shen
- Department of Epidemiology, School of Public Health, Southern Medical University, 510515, Guangzhou, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Qi Fu
- Department of Epidemiology, School of Public Health, Southern Medical University, 510515, Guangzhou, Guangdong, China
| | - Chen Mao
- Department of Epidemiology, School of Public Health, Southern Medical University, 510515, Guangzhou, Guangdong, China.
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Luo X, Chen B, Shen Q. Psychological distress in subsequent pregnancy among women with a history of pregnancy loss: A latent profile analysis. Midwifery 2023; 127:103845. [PMID: 37844394 DOI: 10.1016/j.midw.2023.103845] [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: 02/11/2023] [Revised: 08/28/2023] [Accepted: 10/11/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Women who have undergone pregnancy loss can experience a range of psychological distress during subsequent pregnancies; however, the outcomes may vary based on individual circumstances. OBJECTIVE To explore the potential patterns of psychological distress for pregnant women with a history of pregnancy loss, and to investigate the impact of factors related to pregnancy loss on these patterns. METHODS From October 2022 to August 2023, the participants were recruited from four medical centers in Guangdong Province, China. They completed a questionnaire survey comprising sociodemographic and obstetric characteristics, the Perceived Stress Scale-4 (PSS-4), the Impact of Event Scale-Revised (IES-R), the Pregnancy-related Anxiety Questionnaire-Revised 2 (PRAQ-R2), and the Patient Health Questionnaire-9 (PHQ-9). Latent profile analysis was used to determine optimal patterns of psychological distress. The logistic regression was conducted to assess the associations between the number of pregnancy loss, types of pregnancy loss, inter-pregnancy interval, and distinct psychological distress patterns. RESULTS A total of 446 pregnant women with a history of pregnancy loss were included for formal analysis. Three distinct profiles were identified, namely the "mild psychological distress" (34.1 %), "moderate psychological distress" (57.8 %), and "severe psychological distress" (8.1 %). Recurrent pregnancy loss was associated with increased risks of both moderate (adjusted odds ratio [aOR] 2.45, 95 % confidence interval [CI]: 1.42-4.24; P = 0.001) and severe psychological distress (aOR 2.93, 95 %CI: 1.25-6.83; P = 0.013). Furthermore, compared to women who conceived after 6 months of pregnancy loss, those who conceived within 6 months of pregnancy loss were more likely to be categorized into the group of moderate psychological distress (aOR 2.00, 95 % CI: 1.21-3.30; P = 0.007). CONCLUSIONS Approximately two-thirds of pregnant women with a history of pregnancy loss exhibit moderate to severe psychological distress. Such individuals could benefit from early screening and targeted psychological interventions, particularly those who have encountered recurrent pregnancy loss and those who conceive shortly after a pregnancy loss.
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Affiliation(s)
- Xiangping Luo
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China; Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Bizhen Chen
- Department of Obstetrics and Gynecology, The Tenth Affiliated Hospital of Southern Medical University (Dongguan People's Hospital), Southern Medical University, Dongguan, Guangdong, China
| | - Qiaoqiao Shen
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China.
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Gebeyehu NA, Tegegne KD, Abebe K, Asefa Y, Assfaw BB, Adella GA, Alemu BW, Sewyew DA. Global prevalence of post-abortion depression: systematic review and Meta-analysis. BMC Psychiatry 2023; 23:786. [PMID: 37884930 PMCID: PMC10605843 DOI: 10.1186/s12888-023-05278-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Depression after abortion is a common problem for all women of reproductive age. However, there are not any data on post-abortion depression at a global level. Consequently, the purpose of this study was to find out the global prevalence of post-abortion depression. METHODS The present study involved a comprehensive search of several databases, including Science Direct, Scopus, EMBSE, Google Scholar, and PubMed. The search was conducted between February 1, 2023, and March 10, 2023. The data was extracted using Microsoft Excel (version 14) and analyzed using STATA statistical software. To evaluate publication bias, a forest plot, Begg's test, and Egger's test were employed. Heterogeneity was assessed using I2, and a pooled estimated analysis was conducted. Additionally, subgroup analysis was performed based on the study continent/region, World Bank income group, screening instrument, and study design. RESULTS This analysis included 15 papers with a total of 18,207 research participants out of a total of 657 articles. The overall pooled prevalence of post-abortion depression was found to be 34.5% (95% CI: 23.34, 45.68), with an I2 value of 71.6%. The prevalence of post-abortion depression varied based on geographic location, World Health Organization (WHO) regions, World Bank income category, screening approach, and study design. The highest proportion of post-abortion depression was observed in Asia (37.5%), while the WHO's Eastern Mediterranean region had the greatest rate of post-abortion depression (43.1%). Lower-middle-income countries had the highest frequency of post-abortion depression (42.91%) based on World Bank economic classification. The Center of Epidemiological Studies Depression Scale was found to have the highest incidence of reported depression prevalence (30%) across diagnostic tools. Furthermore, the prevalence of depression was higher in cross-sectional study designs (36.42%) compared to cohort studies (22.7%). CONCLUSION In conclusion, the occurrence of post-abortion depression has been observed to be widespread globally. The prevalence of post-abortion is found to be influenced by several factors, including the methodology employed in the study, the diagnostic tool utilized, the geographical location, and the socioeconomic status of the population. Healthcare providers should prioritize the provision of post-abortion counseling, care, and emotional support to women.
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Affiliation(s)
- Natnael Atnafu Gebeyehu
- School of Midwifery, College of Medicine and Health Sciences, Wolaita Sodo University, Sodo, Ethiopia.
| | - Kirubel Dagnaw Tegegne
- Department of Comprehensive Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Kelemu Abebe
- School of Midwifery, College of Medicine and Health Sciences, Wolaita Sodo University, Sodo, Ethiopia
| | - Yibeltal Asefa
- Department of Public Health, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
| | - Belete Birhan Assfaw
- Department of Psychiatry, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
| | - Getachew Asmare Adella
- Department of Reproductive Health, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
| | - Biresaw Wassihun Alemu
- Department of Midwifery, College of Medicine and Health Science, Indiana University, Injibara, Ethiopia
| | - Dagne Addisu Sewyew
- Department of Midwifery, College of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
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Koert E, Hartwig TS, Hviid Malling GM, Schmidt L, Nielsen HS. 'You're never pregnant in the same way again': prior early pregnancy loss influences need for health care and support in subsequent pregnancy. Hum Reprod Open 2023; 2023:hoad032. [PMID: 37577178 PMCID: PMC10412407 DOI: 10.1093/hropen/hoad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/14/2023] [Indexed: 08/15/2023] Open
Abstract
STUDY QUESTION What are couples' needs for health care and support in a subsequent pregnancy after prior early pregnancy loss (PL) and how do needs change across the pregnancy? SUMMARY ANSWER Couples described unmet needs for pregnancy care in the first 20 weeks of pregnancy and were more satisfied with the care provided during the remainder of the pregnancy. WHAT IS KNOWN ALREADY Despite early PL being common (∼25% of pregnancies), there is a paucity of research to guide practice to optimize treatment and support future pregnancies. There has been low priority for the issue in research and a pervasive acceptance that couples should 'just try again' after experiencing PL. Women with prior PL report increased anxiety during the first trimester of pregnancy compared to those without previous PL. No longitudinal studies explore what couples' needs are throughout the pregnancy and how these needs shift across time. STUDY DESIGN SIZE DURATION This was a qualitative longitudinal dyadic (joint) interview study. In total, 15 couples who were pregnant after a prior PL were interviewed four times over their pregnancy. Couples were recruited from the Copenhagen Pregnancy Loss Cohort Research Programme. Interviews were held in person at the hospital or university, or online. Interviews ranged from 20 to 91 min (mean = 54 min). PARTICIPANTS/MATERIALS SETTING METHODS Inclusion criteria included couples with one to two prior early PL(s) who self-reported a new pregnancy and were willing to be interviewed together and in English. Couples were interviewed four times: after a positive pregnancy test and once in each trimester. Interviews were transcribed and data were analysed using thematic analysis to compare and contrast needs of the couples at each of the four time periods in the pregnancy and across the entire pregnancy. One same-sex couple and 14 heterosexual couples participated. MAIN RESULTS AND THE ROLE OF CHANCE Couples' needs were categorized into two main longitudinal themes across the pregnancy, divided by the 20-week scan. Within each longitudinal theme, there were two themes to represent each time period. In the longitudinal theme 'The first 20 weeks: a 'scary' gap in care' there were two themes: Positive pregnancy test: 'Tell them it's not the same pregnancy' and First trimester: 'We craved that someone was taking care of us'. The standard pregnancy care offered in the public healthcare system in Denmark includes a scan at 12 and 20 weeks. While all couples wished for additional access to scans and monitoring of the foetus in early pregnancy to provide reassurance and detect problems early, they described considerable variation in the referrals and care they were offered. Both partners expressed a high degree of worry and anxiety about the pregnancy, with pregnant women in particular describing 'surviv[ing] from scan to scan' in the early weeks. Couples took scans wherever offered or paid for comfort scans, but this resulted in fragmented care. Instead, they wished for continuity in care, and acknowledgement and sensitivity that a pregnancy after PL is not the same as a first pregnancy. In the longitudinal theme 'The second 20 weeks: Safety in the care system' there were two themes: Second trimester: 'I think we are in good hands' and Third trimester: 'It's more of a 'nice to know' everything is OK than a 'need to know'. Couples reported their distress was lower and overall needs for care were met during this time. They expressed general satisfaction with regular or extended antenatal support although, as in the first 20 weeks, additional acknowledgement and sensitivity regarding their history of PL was desired. Couples said they felt more secure given that they had access to a 24-hour telephone support by midwife/nurse if they had any concerns or questions. LIMITATIONS REASONS FOR CAUTION Participants were self-selected from an ongoing cohort study of patients presenting at hospital with PL. Single women were not included in the study. This study was limited to data collection in Denmark; however, other countries with public healthcare systems may have similar offerings with regard to their provision of antenatal care, care provided in recurrent pregnancy loss (RPL) clinics and the availability of private scans. WIDER IMPLICATIONS OF THE FINDINGS The findings underscore that an early PL creates an increased need for monitoring and care in a subsequent pregnancy. This study highlights a gap in pregnancy care for those with a history of PL given that their need for monitoring and support is high in the early weeks of a new pregnancy before they have access to antenatal care, and before they have had multiple PLs and can be referred to the RPL unit. STUDY FUNDING/COMPETING INTERESTS This project has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 101028172 for E.K. The Copenhagen Pregnancy Loss Cohort is funded by a grant from the BioInnovation Institute Foundation. H.S.N. has received scientific grants from Freya Biosciences, Ferring Pharmaceuticals, BioInnovation Institute, Ministry of Education, Novo Nordisk Foundation, Augustinus Fonden, Oda og Hans Svenningsens Fond, Demant Fonden, Ole Kirks Fond, and Independent Research Fund Denmark. H.S.N. received personal payment or honoraria for lectures and presentations from Ferring Pharmaceuticals, Merck, Astra Zeneca, Cook Medical, Gedeon Richter, and Ibsa Nordic. All other authors declare no competing interests.
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Affiliation(s)
- E Koert
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen K, Denmark
- Department of Obstetrics and Gynecology, Amager Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - T S Hartwig
- Department of Obstetrics and Gynecology, Amager Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - G M Hviid Malling
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen K, Denmark
| | - L Schmidt
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen K, Denmark
| | - H S Nielsen
- Department of Obstetrics and Gynecology, Amager Hvidovre Hospital, Copenhagen University Hospital, Recurrent Pregnancy Loss Unit, Hvidovre, Denmark
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Studnicki J, Longbons T, Fisher J, Reardon DC, Skop I, Cirucci CA, Harrison DJ, Craver C, Tsulukidze M, Ras Z. A Cohort Study of Mental Health Services Utilization Following a First Pregnancy Abortion or Birth. Int J Womens Health 2023; 15:955-963. [PMID: 37342485 PMCID: PMC10278648 DOI: 10.2147/ijwh.s410798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/26/2023] [Indexed: 06/23/2023] Open
Abstract
Objective To determine whether exposure to a first pregnancy outcome of induced abortion, compared to a live birth, is associated with an increased risk and likelihood of mental health morbidity. Materials and methods Participants were continuously eligible Medicaid beneficiaries age 16 in 1999, and assigned to either of two cohorts based upon the first pregnancy outcome, abortion (n = 1331) or birth (n = 3517), and followed through to 2015. Outcomes were mental health outpatient visits, inpatient hospital admissions, and hospital days of stay. Exposure periods before and after the first pregnancy outcome, a total of 17 years, were determined for each cohort. Findings Women with first pregnancy abortions, compared to women with births, had higher risk and likelihood of experiencing all three mental health outcome events in the transition from pre- to post-pregnancy outcome periods: outpatient visits (RR 2.10, CL 2.08-2.12 and OR 3.36, CL 3.29-3.42); hospital inpatient admissions (RR 2.75, CL 2.38-3.18 and OR 5.67, CL 4.39-7.32); hospital inpatient days of stay (RR 7.38, CL 6.83-7.97 and OR 19.64, CL 17.70-21.78). On average, abortion cohort women experienced shorter exposure time before (6.43 versus 7.80 years), and longer exposure time after (10.57 versus 9.20 years) the first pregnancy outcome than birth cohort women. Utilization rates before the first pregnancy outcome, for all three utilization events, were higher for the birth cohort than for the abortion cohort. Conclusion A first pregnancy abortion, compared to a birth, is associated with significantly higher subsequent mental health services utilization following the first pregnancy outcome. The risk attributable to abortion is notably higher for inpatient than outpatient mental health services. Higher mental health utilization before the first pregnancy outcome for birth cohort women challenges the explanation that pre-existing mental health history explains mental health problems following abortion, rather than the abortion itself.
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Affiliation(s)
| | | | - John Fisher
- Charlotte Lozier Institute, Arlington, VA, USA
| | | | - Ingrid Skop
- Charlotte Lozier Institute, Arlington, VA, USA
| | | | - Donna J Harrison
- American Association of Pro-Life Obstetricians and Gynecologists, Eau Claire, MI, USA
| | | | - Maka Tsulukidze
- Department of Health Sciences, Florida Gulf Coast University, Fort Myers, FL, USA
| | - Zbigniew Ras
- Computer Science Department, University of North Carolina at Charlotte, Charlotte, NC, USA
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The Tilburg Pregnancy Distress Scale revised (TPDS-R): Psychometric aspects in a longitudinal cohort study. J Psychiatr Res 2022; 156:511-519. [PMID: 36351306 DOI: 10.1016/j.jpsychires.2022.10.060] [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: 07/29/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
Pregnant women may be specifically prone to experience pregnancy-specific distress, which has been associated with adverse maternal, pregnancy and child outcomes. Accurately identifying pregnancy-specific distress is thus crucial. The Tilburg Pregnancy Distress Scale (TPDS) - translated into many different languages - was previously developed to measure pregnancy-specific distress, resulting in a 16-item screening scale with a partner involvement dimension (PI) and a negative affect dimension (NA). A critical evaluation of the psychometric properties of the TPDS-NA items and feedback from pregnant women over the last decade has led to the need to revise the TPDS. Therefore, in the current study, we describe the procedure for revision and evaluate the psychometric properties of the revised TPDS (TPDS-R). More specifically, we describe the revision of the TPDS-R-PI (4 items) and the TPDS-R-NA (10 items: five-item pregnancy and five-item childbirth subcomponent). A sample of 1081 pregnant women participating in the Brabant Study completed the TPDS-R at 12, 20 and 28 weeks of pregnancy. An exploratory factor analysis and confirmatory factor analysis, descriptive statistics and repeated measures ANOVA demonstrated good test-retest reliability, concurrent validity, internal consistency, and construct validity of the TPDS-R. The TPDS-R provides a robust screening tool to accurately identify pregnant women at risk of pregnancy-specific distress.
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Flannery C, Burke LA, Gillespie P, O'Donoghue K. Estimating the costs associated with the implementation of a best practice model of care for recurrent miscarriage clinics in Ireland: a cost analysis. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13625.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Recurrent miscarriage (RM) affects 1%-5% of the reproductive age population. Given increasing calls for dedicated recurrent miscarriage clinics (RMC), decision makers will require data on the resultant budgetary implications. The aim of this study was to identify the potential costs to the Irish healthcare system of implementing a best practice RMC model of care. Methods A ‘best practice’ RMC was developed as part of the RE:CURRENT Project. A micro-costing approach was employed by identifying, measuring, and valuing resource usage by unit costs for the RMC for ≥2 consecutive losses. Per patient costs were estimated using two care pathway scenarios: typical and complex. Per patient costs were extrapolated, using population data and published prevalence rates for RM, to estimate the total cost to the Irish health system. A sensitivity analysis was also performed. Results The cost for a RM patient who has another pregnancy after receiving investigations, treatment and reassurance scans ranges between €1,634 (typical) and €4,818 (complex). For a RM patient who does not conceive again, costs range from €1,384 (typical) to €4,318 (complex). Using population estimates for ≥2 losses, the total cost to the Irish health service ranges from €20,336,229 (complex) to €61,927,630 (typical) for those who progress to pregnancy, and from €7,789,437 (complex) to €22,480,630 (typical) for those who do not progress to another pregnancy. Together, the total cost of the proposed best practice RMC is €112,533,926 with an average cost per patient €1,871. Conclusions This study advocates for a new model of care for RMCs in Ireland and provides a set of cost estimates at the patient and healthcare system level. While future studies should explicitly consider the cost effectiveness of this or similar models of care, this analysis provides a valuable first step in providing a detailed breakdown of the associated costs and budget implications.
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Regassa LD, Tola A, Daraje G, Dheresa M. Trends and determinants of pregnancy loss in eastern Ethiopia from 2008 to 2019: analysis of health and demographic surveillance data. BMC Pregnancy Childbirth 2022; 22:671. [PMID: 36045340 PMCID: PMC9429487 DOI: 10.1186/s12884-022-04994-4] [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: 06/13/2021] [Accepted: 08/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background Pregnancy losses remain a neglected issue and it will be taking more than a century before a pregnant woman in Sub Sahara has the same chance of her baby being born alive as a woman in a high-income country. Pregnancy loss data are limited and not universal in Sub Saharan countries. This study was aimed to assess the magnitude and determinants of pregnancy loss in eastern Ethiopia. Methods This study was conducted in, open continues and dynamic cohort of population, Kersa Health and Demographic Survillance site (HDSS) in Eastern Ethiopia in 2008–2019. All mothers who had known pregnancy outcomes during the period and reside in Kersa HDSS were considered. The prevalence proportions were calculated as the sum of all pregnancy loss divided by the number births in the specified year. Log-Binomial regression was used to determine factors associated with pregnancy loss. Prevalence Proportion Ratio (PPR) was used to report the magnitude and strength of association. A p-value of less than 0.05 was considered statistically significant. Results From 39,153 included pregnancies, 810 (20.7; 95%CI:19.32, 22.15 per 1000 births) experienced pregnancy loss. Stillbirth was higher than abortion (11.14 Vs. 9.55 per 1000 births). Lacking own income (aPPR:1.26; 95%CI: 1.01, 1.58), being daily laborer (aPPR:1.44; 95%:1.08, 306) history of previous pregnancy loss (aPPR:2.26, 95%CI:1.69, 3.03), unwanted pregnancy (aPPR:1.26; 95%CI:1.01, 1.80), not receiving antenatal care (aPPR:1.59; 95%CI: 1.19, 2.13) and not receive the TT-vaccine during pregnancy (aPPR:1.33; 95%CI: 1.08, 1.80) were positively associated with pregnancy loss. Conclusions The overall rate pregnancy loss was ranged between 19.32, 22.15 per 1000 births with higher still births than miscarriage or abortion. Pregnancy loss was positively associated with social factors reproductive health factors, and maternal health service utilization.
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Coleman PK. The Turnaway Study: A Case of Self-Correction in Science Upended by Political Motivation and Unvetted Findings. Front Psychol 2022; 13:905221. [PMID: 35783786 PMCID: PMC9247501 DOI: 10.3389/fpsyg.2022.905221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/24/2022] [Indexed: 01/14/2023] Open
Abstract
This review begins with a detailed focus on the Turnaway Study, which addresses associations among early abortion, later abortion, and denied abortion relative to various outcomes including mental health indicators. The Turnaway Study was comprised of 516 women; however, an exact percentage of the population is not discernable due to missing information. Extrapolating from what is known reveals a likely low of 0.32% to a maximum of 3.18% of participants sampled from the available the pool. Motivation for conducting the Turnaway Study, methodological deficiencies (sampling issues and others), and bias are specifically addressed. Despite serious departures from accepted scientific practices, journals in psychology and medicine have published dozens of articles generated from the study's data. The high volume of one-sided publications has stifled dialogue on potential adverse psychological consequences of this common procedure. Following a critical analysis of the Turnaway Study, an overview of the strongest studies on abortion and mental health is offered. This comprehensive literature comprised of numerous large-scale studies from across the globe has been largely overlooked by scientists and the public, while the Turnaway Study dominates the media, information provided to women, and legal challenges involving abortion restrictions. In the final section of this article, literature reviews by professional organizations are considered, demonstrating that the biased science characterizing the Turnaway Study is aligned with a pervasive and systemic phenomenon wherein deriving reliable and valid results via careful attention to methodology and scrutiny by the scientific community have been supplanted by politics.
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Affiliation(s)
- Priscilla K. Coleman
- Human Development and Family Studies, Bowling Green State University, Bowling Green, OH, United States
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11
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Hini JD, Kayem G, Quibel T, Berveiller P, De Carne Carnavale C, Delorme P. Risk of preterm delivery after medically indicated termination of pregnancy with induced vaginal delivery: a case-control study. J OBSTET GYNAECOL 2022; 42:1693-1702. [PMID: 35653800 DOI: 10.1080/01443615.2022.2071147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We investigated whether nonsurgical termination of pregnancy after 14 weeks of gestation increases the risk of preterm delivery in a subsequent pregnancy. We conducted a two-centre retrospective case-control study. Patients who underwent non-surgical termination of pregnancy after 14 weeks of gestation between 2012 and 2015 and who gave birth after 14 weeks of gestation to a live-born singleton infant were included. Control patients were those who gave birth after 37 weeks of gestation (the same month as a case patient) and had a second delivery of a singleton foetus after 14 weeks of gestation. The primary outcome was preterm delivery during the second pregnancy period. We included 151 cases and 302 controls and observed 13 (8.6%) preterm births during the second pregnancy in the case group versus 8 (2.6%) (odds ratio: 3.62; 95% confidence interval: 1.40-8.65, p < .001) in the control group. This result remained significant after multivariate analysis. Impact statementWhat is already known about this topic? Many studies have evaluated the association between first-trimester surgical or non-surgical termination of pregnancy and the risk of preterm birth in the subsequent pregnancy. However, no study has evaluated the association between second- or third-trimester non-surgical termination of pregnancy due to foetal disease and the risk of preterm birth in the subsequent pregnancy. A small number of studies have included a small proportion of patients who previously underwent non-surgical termination of pregnancy after 14 weeks of gestation and later experienced first-trimester termination during their second pregnancy. These studies focussed on the impact of the interpregnancy interval or pharmacological induction of labour on the risk of preterm delivery in the subsequent pregnancy.What did the results of this study add? This is the first study to specifically evaluate the association between second- and third-trimester non-surgical terminations of pregnancy and the risk of preterm birth in the subsequent pregnancy. When compared with term birth, nonsurgical termination of pregnancy was associated with the risk of spontaneous preterm birth and hospitalisation in the neonatal intensive care unit in the subsequent pregnancy.What are the implications of these findings for clinical practice and further research? Further studies are required to confirm our results, but information delivered to patients with a late termination of pregnancy and during their pregnancy follow-up for the subsequent pregnancy could be modified to provide this information.
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Affiliation(s)
- Jean-Daniel Hini
- Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP, Paris, France.,Sorbonne Université, Paris, France
| | - Gilles Kayem
- Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP, Paris, France.,Sorbonne Université, Paris, France
| | - Thibaud Quibel
- Department of Obstetrics and Gynecology, Poissy-Saint Germain en Laye Hospital Center, Poissy, France
| | - Paul Berveiller
- Department of Obstetrics and Gynecology, Poissy-Saint Germain en Laye Hospital Center, Poissy, France
| | | | - Pierre Delorme
- Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP, Paris, France.,Sorbonne Université, Paris, France
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12
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Berengere BM, Jessica S, Diane DW, Marie-Emmanuelle M, Marie-José S, Lisa O, Grosmaitre C, Laurent J S, Bernard G, Ville Y, Sylvain M. Prenatal attachment, anxiety and grief during subsequent pregnancy after medical termination of pregnancy. Attachment to which child? J Gynecol Obstet Hum Reprod 2022; 51:102353. [PMID: 35247609 DOI: 10.1016/j.jogoh.2022.102353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/17/2022] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate emotional distress and prenatal attachment throughout a subsequent pregnancy after Termination of Pregnancy (TOP) for fetal abnormality. METHODS Observational study, in a French Tertiary Maternity. POPULATION 25 women in a subsequent pregnancy after a medical termination of pregnancy for foetal abnormality, 18-year-old and older. Prenatal Interviews at 20 Gestationnal weeks (GW), 27 GW and 35 GW and Postnatal at 3 months and at each time self-administered questionnaires of anxiety, post-traumatic stress syndrome (PCLS) depressive symptoms (EPDS), prenatal attachment (PAI) and Perinatal Grief Scale (PGS). RESULTS Pregnancy onset, i.e. before 20 GW, showed increased prevalence of anxiety (16/23, 66.7%), depression (7/23, 30.4%) and post-traumatic stress symptoms (4/16, 25%). Total score on PGS is higher in onset of pregnancy than in the third trimester (p=0.005). Prenatal attachment was lower during early pregnancy (p = 0.003) and correlated inversely with grief intensity (p = 0.022). During late pregnancy, emotional symptoms decrease, and prenatal attachment stopped increase positively, specifically among women whose foetal abnormality in previous pregnancies were diagnosed late, at an average of 25 GW. CONCLUSION This research shows the specific dynamics of pregnancies following TOP and highlights the necessity for early prenatal psychological support. One should also pay special attention to prenatal attachment during late pregnancy even after knowing that the fetus is healthy.
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Affiliation(s)
- Beauquier-Maccotta Berengere
- Child Psychiatry Department, Perinatal unit, Necker Enfant Malades Hospital, Paris France; Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse (PCPP, EA 4056), Paris Descartes University.
| | - Shulz Jessica
- Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse (PCPP, EA 4056), Paris Descartes University; EPS Ville-Evrard, Infant psychiatry 93i05, 202, avenue Jean Jaurès, 93330 Neuilly-sur-Marne
| | - De Wailly Diane
- Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse (PCPP, EA 4056), Paris Descartes University; Maternity and foetal medicine department Necker Enfant Malades Hospital France
| | | | | | - Ouss Lisa
- Child Psychiatry Department, Necker Enfant Malades Hospital, APHP Paris France. Université de Paris
| | - Catherine Grosmaitre
- Child Psychiatry Department, Necker Enfant Malades Hospital, APHP Paris France. Université de Paris
| | - Salomon Laurent J
- Child Psychiatry Department, Necker Enfant Malades Hospital, APHP Paris France. Université de Paris
| | - Golse Bernard
- Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse (PCPP, EA 4056), Paris Descartes University
| | - Yves Ville
- Maternity and foetal medicine department, Necker Enfant Malades Hospital, Paris France. EA 7328, Université de Paris
| | - Missonnier Sylvain
- Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse (PCPP, EA 4056), Paris Descartes University
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13
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Ker CR, Wu CH, Lee CH, Wang SH, Chan TF. Increased sugar-sweetened beverage use tendency in pregnancy positively associates with peripartum Edinburgh postpartum depression scores. Sci Rep 2021; 11:15324. [PMID: 34321556 PMCID: PMC8319412 DOI: 10.1038/s41598-021-94790-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/16/2021] [Indexed: 12/28/2022] Open
Abstract
The association among sugar sweetened beverages (SSB) consumption, addiction and depression in adults, children and adolescents is widely reported. Dieting patterns during pregnancy is complicated by maternal fetal concerns. Specifically, restrained use of SSB might be potentially a source of perinatal distress. The current study modified diagnostic criteria for Substance Use Disorder (SUD) in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), into SSB-specific questions to assess SSB use tendency. Edinburgh Postpartum Depression Scores (EPDS) is used to assess maternal distress during pregnancy. One hundred and ninety-six consecutive pregnant women receiving antenatal care at Kaohsiung Medical University Hospital were invited to participate in this study. In the first trimester, 46.6% of women had none or 1 DSM-5 symptom, 27.0% had 2–3 symptoms, while 26.4% had ≥ 4 symptoms. The mean numbers of DSM-5 symptoms in each trimester were found to be 2.5 ± 2.25, 2.6 ± 2.45, 2.4 ± 2.43 for the first, second and third trimester, respectively, p = 0.750. While EPDS score showed no difference among DSM-5 symptoms 0–1, 2–3 and ≥ 4 groups in the first trimester (8.1 ± 4.59, 8.4 ± 5.00, 8.8 ± 4.82, p = 0.343), women with ≥ 4 DSM-symptoms was found significantly higher EPDS scores than those with < 4 DSM-symptoms in the second (7.2 ± 4.81, 7.7 ± 4.98, 8.8 ± 4.33, p = 0.030) and third trimester (6.8 ± 5.00, 7.2 ± 4.63, 8.7 ± 5.24, p = 0.019). The relationship remained significant after adjusting for covariates including actual SSB amount consumed (adjusted β = 0.25 with 95% confident interval (CI) 0.04–0.45 and 0.21 with 95% CI 0.04–0.38 for the second and third trimesters, respectively). Overall, the study is the first to characterize the positive relationship between SSB use tendency and antenatal distress in pregnancy, independent of actual SSB amount consumed. The observational nature of the study design precludes inferences of its underlying socio-psychomotor mechanisms, although restrained SSB use in pregnancy is suspected to contribute. The novel employment of modified SSB-specific DSM-5 scores and EPDS in this setting is feasible and further validation is promising. With better understanding and awareness, pregnant women with increased SSB use tendency should be properly counseled with special attention to their mental state.
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Affiliation(s)
- Chin-Ru Ker
- Department of Obstetrics and Gynecology, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou 1st Road, Kaohsiung, 807, Taiwan
| | - Chen-Hsuan Wu
- Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan. .,Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Dapi Road, Niaosong District, Kaohsiung, 833, Taiwan.
| | - Chien-Hung Lee
- Department of Public Health, College of Health Science, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Sanmin District, Kaohsiung, 807, Taiwan
| | - Shih-Han Wang
- Department of Obstetrics and Gynecology, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou 1st Road, Kaohsiung, 807, Taiwan
| | - Te-Fu Chan
- Department of Obstetrics and Gynecology, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou 1st Road, Kaohsiung, 807, Taiwan. .,Center of Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
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14
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Complementary and Alternative Medicine for Threatened Miscarriage: Advantages and Risks. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021. [DOI: 10.1155/2021/5589116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Threatened miscarriage is one of the most common complications causing pregnancy loss, and it affects approximately 20% of confirmed pregnancies. More and more women are seeking treatment with complementary and alternative medicine (CAM) for this common complication, and it has been reported that women have had successful pregnancies after threatened miscarriage when being treated with CAM, which mainly includes Chinese herbal medicines, acupuncture, and nutritional supplements as well as psychological interventions and other approaches. However, many experts are concerned about the safety and adverse events of certain CAM approaches in women with threatened miscarriage. Therefore, this review focuses on the status of CAM for threatened miscarriage and presents the potential therapeutic efficacy and safety of CAM based on some clinical and experimental studies. We thus hope to provide some instructive suggestions for the application of CAM for treating threatened miscarriage in the future.
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15
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Chang SC, Kuo PL, Chen CH. Effectiveness of empathic caring on stress and depression for women with recurrent miscarriage: A randomized controlled trial. Complement Ther Clin Pract 2021; 43:101367. [PMID: 33770739 DOI: 10.1016/j.ctcp.2021.101367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/21/2021] [Accepted: 03/13/2021] [Indexed: 01/27/2023]
Abstract
AIM The purpose of this study was to investigate the effectiveness of empathic caring on sleep quality, depression, stress, and social support in women with recurrent miscarriage. MATERIALS AND METHODS Sixty-two eligible women were randomly assigned to either the experimental group (n = 31), which received three face-to-face nursing counseling sessions, or the control group (n = 31). Outcome measures included the Pittsburgh Sleep Quality Index, Edinburgh Prenatal Depression Scale, Perceived Stress Scale, and Interpersonal Support Evaluation List. RESULTS Paired-sample t-tests revealed that, after receiving nursing counseling, the participants in the experimental group showed significant decreases in stress and depression. However, no significant mean differences were found in the control group between the pretest and the 12-week posttest for any of the four outcome measures. CONCLUSION Clinical healthcare professionals may incorporate empathic caring into health-promotion protocols to assist women with recurrent miscarriage to improve their psychosocial health.
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Affiliation(s)
- Shu-Chen Chang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 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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16
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Hennessy M, Dennehy R, Meaney S, Linehan L, Devane D, Rice R, O'Donoghue K. Clinical practice guidelines for recurrent miscarriage in high-income countries: a systematic review. Reprod Biomed Online 2021; 42:1146-1171. [PMID: 33895080 DOI: 10.1016/j.rbmo.2021.02.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
Recurrent miscarriage affects 1-2% of women of reproductive age, depending on the definition used. A systematic review was conducted to identify, appraise and describe clinical practice guidelines (CPG) published since 2000 for the investigation, management, and/or follow-up of recurrent miscarriage within high-income countries. Six major databases, eight guideline repositories and the websites of 11 professional organizations were searched to identify potentially eligible studies. The quality of eligible CPG was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE II) Tool. A narrative synthesis was conducted to describe, compare and contrast the CPG and recommendations therein. Thirty-two CPG were included, from which 373 recommendations concerning first-trimester recurrent miscarriage were identified across four sub-categories: structure of care (42 recommendations, nine CPG), investigations (134 recommendations, 23 CPG), treatment (153 recommendations, 24 CPG), and counselling and supportive care (46 recommendations, nine CPG). Most CPG scored 'poor' on applicability (84%) and editorial independence (69%); and to a lesser extent stakeholder involvement (38%) and rigour of development (31%). Varying levels of consensus were found across CPG, with some conflicting recommendations. Greater efforts are required to improve the quality of evidence underpinning CPG, the rigour of their development and the inclusion of multi-disciplinary perspectives, including those with lived experience of recurrent miscarriage.
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Affiliation(s)
- Marita Hennessy
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; College of Medicine and Health, University College Cork Cork T12 EKDO, Ireland.
| | - Rebecca Dennehy
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; College of Medicine and Health, University College Cork Cork T12 EKDO, Ireland
| | - Sarah Meaney
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; College of Medicine and Health, University College Cork Cork T12 EKDO, Ireland; National Perinatal Epidemiology Centre, University College Cork, Cork University Maternity Hospital Cork T12 DC4A, Ireland
| | - Laura Linehan
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; College of Medicine and Health, University College Cork Cork T12 EKDO, Ireland
| | - Declan Devane
- The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; School of Nursing and Midwifery, National University of Ireland, Galway, Galway H91 E3YV, Ireland; Evidence Synthesis Ireland, National University of Ireland, Galway, Galway H91 E3YV, Ireland
| | - Rachel Rice
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; School of Applied Social Studies, University College Cork, Cork T12 D726, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; College of Medicine and Health, University College Cork Cork T12 EKDO, Ireland
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17
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La X, Wang W, Zhang M, Liang L. Definition and Multiple Factors of Recurrent Spontaneous Abortion. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1300:231-257. [PMID: 33523437 DOI: 10.1007/978-981-33-4187-6_11] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Recurrent spontaneous abortion (RSA) is usually defined as three or more spontaneous abortions prior to 20-28 weeks gestation. RSA affects approximately 2-5% of all women of childbearing age, and it brings tremendous psychological and psychiatric trauma to the women and also results in economic burden. The causes could be female age, anatomical and chromosomal abnormalities, genetic, endocrinological, placental anomalies, infection, smoking and alcohol consumption, psychological factor, exposure to environmental factors such as heavy metal, environment pollution, and radiation.
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Affiliation(s)
- Xiaolin La
- Reproductive Medicine Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
| | - Wenjuan Wang
- Reproductive Medical Center, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, P.R. China
| | - Meng Zhang
- Reproductive Medicine Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Li Liang
- Reproductive Medical Center, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, P.R. China
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18
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Ali N, Elbarazi I, Ghazal-Aswad S, Al-Maskari F, H Al-Rifai R, Oulhaj A, Loney T, A Ahmed L. Impact of Recurrent Miscarriage on Maternal Outcomes in Subsequent Pregnancy: The Mutaba'ah Study. Int J Womens Health 2020; 12:1171-1179. [PMID: 33324118 PMCID: PMC7733378 DOI: 10.2147/ijwh.s264229] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/12/2020] [Indexed: 01/28/2023] Open
Abstract
Purpose To estimate the prevalence of recurrent miscarriage (RM) and investigate the association between RM and adverse maternal outcomes in subsequent pregnancies. Participants and Methods This is an interim analysis of a prospective study of 1737 pregnant women with gravidity of two or more prior to the current pregnancy. These women joined the Mutaba’ah Study between May 2017 and April 2019 and were followed up until they delivered. Hospital medical records were used to extract data on past pregnancy history and the progress and outcomes of the current pregnancy, such as gestational diabetes, preeclampsia, mode of delivery, preterm delivery, and complications at birth. Results Amongst pregnant women with at least two previous pregnancies (n=1737), there were 234 (13.5%) women with a history of two or more consecutive miscarriages. Women with RM were slightly older, more parous, and more likely to have had previous infertility treatment (all p-values <0.05). Women with a history of RM had independently significant increased odds of cesarean section (adjusted odds ratio (aOR) 1.81, 95% CI 1.24–2.65) and preterm (<37 weeks, aOR: 2.52, 95% CI 1.56–4.08) or very preterm delivery (<32 weeks, aOR: 7.02 95% CI 2.41–20.46) in subsequent pregnancies than women who did not have a history of RM. Conclusion Women with a history of RM were twice as likely to undergo cesarean section and seven times more likely to deliver prior to 32 weeks of gestation than women without a history of RM. The study findings support the need for early pregnancy monitoring or assessment units to ensure better follow-up and customized care for at-risk pregnant women with a history of RM.
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Affiliation(s)
- Nasloon Ali
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Iffat Elbarazi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Saad Ghazal-Aswad
- Obstetrics and Gynecology Department, Tawam Hospital, Al Ain, United Arab Emirates
| | - Fatima Al-Maskari
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Zayed Centre for Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Rami H Al-Rifai
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Zayed Centre for Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Abderrahim Oulhaj
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Zayed Centre for Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Luai A Ahmed
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Zayed Centre for Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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19
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Voltas N, Arija V, Hernández-Martínez C, Nappi L, Cibelli G, Basora J, Canals J. Perinatal emotional states: a comparative study between two cohorts recruited in a Mediterranean environment. Women Health 2020; 61:221-234. [PMID: 33213300 DOI: 10.1080/03630242.2020.1847749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Experiencing negative emotional states during pregnancy has been linked to adverse outcomes for mother and offspring. Our study aims were to compare the perinatal emotional states and obstetrical variables between pregnant women recruited in Spain (n = 202) and Italy (n = 103), and to investigate prenatal anxiety related factors. The study had two phases. In the 1st phase (3rd trimester of pregnancy), prenatal anxiety was assessed using the State-Trait Anxiety Inventory (STAI); other prenatal and sociodemographic variables were also collected. In the 2nd phase (40 days postpartum), the STAI and the Edinburgh Postnatal Depression Scale were administered. Compared to the Spanish sample, the Italian sample presented higher STAI state and STAI factor 1 mean scores (22.5 vs. 18.6 and 10.0 vs. 7.2), shorter gestations (mean gestation weeks: 39.1 vs. 39.8), more unplanned pregnancies (31.1% vs. 16.4%), and more cesareans deliveries (42.5% vs. 16.0%). Low socioeconomic levels, younger ages, previous miscarriages and unplanned pregnancies were related to prenatal anxiety. Postpartum depression rates was 31.3% and there were no differences between countries. Our results suggested that it may be interesting in both countries to create a prenatal monitoring protocol that attaches more importance to emotional wellbeing both during pregnancy and in the long term.
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Affiliation(s)
- Núria Voltas
- Research Center for Behavioral Assessment (CRAMC), Department of Psychology, Universitat Rovira I Virgili, Tarragona, Spain.,Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira I Virgili, Spain
| | - Victoria Arija
- Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira I Virgili, Spain.,Nutrition and Public Health Unit, Universitat Rovira I Virgili, Reus, Spain
| | - Carmen Hernández-Martínez
- Research Center for Behavioral Assessment (CRAMC), Department of Psychology, Universitat Rovira I Virgili, Tarragona, Spain.,Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira I Virgili, Spain
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Giuseppe Cibelli
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Josep Basora
- Institut d'Investigació en Atenció Primària Jordi Gol, Tarragona, Spain
| | - Josefa Canals
- Research Center for Behavioral Assessment (CRAMC), Department of Psychology, Universitat Rovira I Virgili, Tarragona, Spain.,Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira I Virgili, Spain
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20
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Freeman A, Neiterman E, Varathasundaram S. Women's experiences of health care utilization in cases of early pregnancy loss: A scoping review. Women Birth 2020; 34:316-324. [PMID: 32859562 DOI: 10.1016/j.wombi.2020.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/22/2020] [Accepted: 07/30/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Approximately 25% of pregnancies end in miscarriage, most occurring within the first trimester (<13 weeks). For many women early pregnancy loss has implications for short- and long- term mental health, and women's well-being following early pregnancy loss is impacted by their experiences within the healthcare setting. To improve quality of care, it is crucial to understand women's' experiences within the healthcare system in cases of early pregnancy loss. QUESTIONS What does the research literature tell us about the experiences of early pregnancy loss within healthcare settings? Are these experiences positive or negative? 'How can care improve for those experiencing early pregnancy loss?' METHODS A scoping review of the research literature was undertaken. Three research databases were searched for relevant articles published in English since 2009, with key words related to 'Experience', 'Healthcare' and 'Early Pregnancy Loss'. A thematic analysis was undertaken to identify and summarize key findings emerging from the research literature. FINDINGS Twenty-seven (27) articles met our inclusion criteria. Three main themes were identified: (1) issues related to communication, (2) challenges within care environments, and (3) inadequacies in aftercare. DISCUSSION The literature suggests that women's experiences related to healthcare for early pregnancy loss are largely negative, particularly within emergency departments. Recommendations to improve women's experiences should extend beyond attempts to improve existing care structures, to include emerging environments and providers. CONCLUSION Women's experiences identified within the literature provide further insights on what women are seeking from their care, and how care models can be improved.
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Affiliation(s)
- Angela Freeman
- School of Public Health and Health Systems (SPHHS), Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Elena Neiterman
- School of Public Health and Health Systems (SPHHS), Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Shya Varathasundaram
- School of Public Health and Health Systems (SPHHS), Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
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Ni T, Wu Q, Zhu Y, Jiang W, Zhang Q, Li Y, Yan J, Chen ZJ. Comprehensive analysis of the associations between previous pregnancy failures and blastocyst aneuploidy as well as pregnancy outcomes after PGT-A. J Assist Reprod Genet 2020; 37:579-588. [PMID: 32103397 PMCID: PMC7125264 DOI: 10.1007/s10815-020-01722-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/13/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To investigate the associations of previous pregnancy failures, including implantation failures (IFs), biochemical pregnancy losses (BPLs), and early (EMs) and late miscarriages (LMs), with blastocyst aneuploidy and pregnancy outcomes after PGT-A. METHODS This study included 792 couples who underwent PGT-A after multiple pregnancy failures. Subgroup analyses were used to compare the blastocyst aneuploidy rate (BAR), implantation rate (IR), early miscarriage rate (EMR), and live birth rate (LBR). Multiple linear and logistic regression models were used to evaluate the associations. The control group comprised couples with ≤ 2 IFs, ≤ 1 BPL, ≤ 1 EM, and no LM. RESULTS Notably, a history of ≥ 4 IFs was significantly associated with an increase in aneuploid blastocysts (42.86% vs. 33.05%, P = 0.044, B = 10.23 for 4 IFs; 48.80% vs. 33.05%, P = 0.002, B = 14.43 for ≥ 5 IFs). Women with ≥ 4 prior EMs also harbored more aneuploid blastocysts (41.00% vs. 33.05%, P = 0.048; B = 9.23). Compared with the control group, women with ≥ 4 prior EMs had a significantly higher EMR (6.58% vs. 31.11%, P < 0.001, OR = 6.49) and a lower LBR (53.49% vs. 34.18%, P = 0.007, OR = 0.56) after euploid transfer. Moreover, a history of LM(s) was associated with adverse pregnancy outcomes after PGT-A (OR for EM = 3.16; OR for live birth = 0.48). However, previous BPLs and 2 EMs were not associated significantly with blastocyst aneuploidy and pregnancy outcomes after PGT-A. CONCLUSION A history of high-order IFs or EMs and existence of LM(s) were significantly associated with blastocyst aneuploidy and adverse pregnancy outcomes after PGT-A, whereas no such associations were observed with BPLs or 2 EMs.
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Affiliation(s)
- Tianxiang Ni
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250001, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Key Laboratory of Reproductive Medicine, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, 157 Jingliu Road, Jinan, 250001, China
| | - Qianqian Wu
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250001, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Key Laboratory of Reproductive Medicine, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, 157 Jingliu Road, Jinan, 250001, China
| | - Yueting Zhu
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250001, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Key Laboratory of Reproductive Medicine, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, 157 Jingliu Road, Jinan, 250001, China
| | - Wenjie Jiang
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250001, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Key Laboratory of Reproductive Medicine, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, 157 Jingliu Road, Jinan, 250001, China
| | - Qian Zhang
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250001, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Key Laboratory of Reproductive Medicine, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, 157 Jingliu Road, Jinan, 250001, China
| | - Yan Li
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250001, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Key Laboratory of Reproductive Medicine, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, 157 Jingliu Road, Jinan, 250001, China
| | - Junhao Yan
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250001, China.
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, 157 Jingliu Road, Jinan, 250001, China.
- Shandong Provincial Key Laboratory of Reproductive Medicine, 157 Jingliu Road, Jinan, 250001, China.
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, 157 Jingliu Road, Jinan, 250001, China.
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250001, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Key Laboratory of Reproductive Medicine, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, 157 Jingliu Road, Jinan, 250001, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, 845 Lingshan Road, Shanghai, 200000, China
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Chen YC, Huang XN, Kong CY, Hu JD. Six families with balanced chromosome translocation associated with reproductive risks in Hainan Province: Case reports and review of the literature. World J Clin Cases 2020; 8:222-233. [PMID: 31970191 PMCID: PMC6962080 DOI: 10.12998/wjcc.v8.i1.222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 11/28/2019] [Accepted: 12/13/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Balanced translocation refers to the process where breakage and reconnection of chromosomes occur at abnormal positions. As the genetic substance with balanced translocation in individuals does not change, which is usually characterized by normal phenotype and intelligence, the individuals seek medical service after many miscarriages, resulting in considerable mental and physical burdens of the family members. In the current era with rapid advances in detection technology, cytogenetic examination, as a definitive approach, still plays an essential role.
CASE SUMMARY We report six cases with balanced chromosome translocation: Case 1: 46,XY,t(3;12)(q27;q24.1), infertility after 3 years of marriage; Case 2: 46,XX,t(4;16)(q31;q12), small uterus and irregular menstruation; Case 3: 46,XY,t(4;5)(q33;q13),9qh+, not pregnant after arrested fetal development; Case 4: 46,XX,t(11;17)(q13;p11.2), not pregnant after two times of spontaneous abortion; Case 5: 46,XX,t(10;13)(q24;q21.2), not pregnant after arrested fetal development for once; Case 6: 46,XX,t(1;4)(p36.1;q31.1), not pregnant after arrested fetal development for two times. The first four cases had chromosomal aberration karyotypes.
CONCLUSION These results suggested that balanced chromosomal translocation carriers are associated with reproductive risks and a very high probability of abnormal pregnancy. The discovery of the first four reported chromosomal aberration karyotypes provides an important basis for studying the occurrence of genetic diseases.
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Affiliation(s)
- Yun-Chun Chen
- Department of Laboratory Medicine, Haikou Branch of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine (Haikou Hospital of Traditional Chinese Medicine), Haikou 570300, Hainan Province, China
| | - Xu-Ning Huang
- Department of Ultrasound Medicine, Second Affiliated Hospital of Hainan Medical University, Haikou 570300, Hainan Province, China
| | - Chang-Ying Kong
- Department of Gynecology, Second Affiliated Hospital of Hainan Medical University, Haikou 570300, Hainan Province, China
| | - Jian-Dong Hu
- Department of Internal Medicine, Haikou Branch of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine (Haikou Hospital of Traditional Chinese Medicine), Haikou 570300, Hainan Province, China
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Furmli H, Seeto RA, Hewko SL, Dalfen A, Jones CA, Murphy KE, Bocking A. Maternal Mental Health in Assisted and Natural Conception: A Prospective Cohort Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1608-1615. [DOI: 10.1016/j.jogc.2019.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/02/2019] [Accepted: 03/04/2019] [Indexed: 10/26/2022]
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Tiemeyer S, Shreffler K, McQuillan J. Pregnancy happiness: implications of prior loss and pregnancy intendedness. J Reprod Infant Psychol 2019. [PMID: 31271303 DOI: 10.1080/02646838.2019.1636944.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
Objective: This study aimed to examine the interaction between pregnancy loss and pregnancy intentions on women's happiness about a subsequent pregnancy.Background: Anxiety about prior loss persist for women, even during subsequent pregnancies. It is unclear from prior research, whether a prior pregnancy loss shapes attitudes towards and feelings about a subsequent birth.Methods: Using data from the 2002-2013 National Survey of Family Growth (NSFG), we used logistic regression analyses to explore the implications of a prior pregnancy loss for happiness about a subsequent pregnancy that ends in a live birth. We compared births classified as on-time, mistimed, unwanted, and ambivalent.Results: Births were more likely to be characterised as on-time if they occurred following a pregnancy loss, and women were less likely to report being happy about a conception if they were ambivalent about the conception and experienced a previous loss. Overall, pregnancy loss alone was not associated with lower levels of happiness about a subsequent birth.Conclusions: Pregnancy loss can be a highly distressing experience, women's happiness about a subsequent pregnancy is not reduced due to prior pregnancy loss. Future research should explore why women who were ambivalent about pregnancy reported lower levels of happiness following a loss.
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Affiliation(s)
- Stacy Tiemeyer
- Department of Human Development and Family Science, Oklahoma State University, Tulsa, OK, USA
| | - Karina Shreffler
- Department of Human Development and Family Science, Oklahoma State University, Stillwater, USA
| | - Julia McQuillan
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, NE, USA
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Tiemeyer S, Shreffler K, McQuillan J. Pregnancy happiness: implications of prior loss and pregnancy intendedness. J Reprod Infant Psychol 2019; 38:184-198. [PMID: 31271303 DOI: 10.1080/02646838.2019.1636944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: This study aimed to examine the interaction between pregnancy loss and pregnancy intentions on women's happiness about a subsequent pregnancy.Background: Anxiety about prior loss persist for women, even during subsequent pregnancies. It is unclear from prior research, whether a prior pregnancy loss shapes attitudes towards and feelings about a subsequent birth.Methods: Using data from the 2002-2013 National Survey of Family Growth (NSFG), we used logistic regression analyses to explore the implications of a prior pregnancy loss for happiness about a subsequent pregnancy that ends in a live birth. We compared births classified as on-time, mistimed, unwanted, and ambivalent.Results: Births were more likely to be characterised as on-time if they occurred following a pregnancy loss, and women were less likely to report being happy about a conception if they were ambivalent about the conception and experienced a previous loss. Overall, pregnancy loss alone was not associated with lower levels of happiness about a subsequent birth.Conclusions: Pregnancy loss can be a highly distressing experience, women's happiness about a subsequent pregnancy is not reduced due to prior pregnancy loss. Future research should explore why women who were ambivalent about pregnancy reported lower levels of happiness following a loss.
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Affiliation(s)
- Stacy Tiemeyer
- Department of Human Development and Family Science, Oklahoma State University, Tulsa, OK, USA
| | - Karina Shreffler
- Department of Human Development and Family Science, Oklahoma State University, Stillwater, USA
| | - Julia McQuillan
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, NE, USA
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Flannery C, Dahly D, Byrne M, Khashan A, McHugh S, Kenny LC, McAuliffe F, Kearney PM. Social, biological, behavioural and psychological factors related to physical activity during early pregnancy in the Screening for Pregnancy Endpoints (Cork, Ireland) cohort study. BMJ Open 2019; 9:e025003. [PMID: 31227527 PMCID: PMC6596951 DOI: 10.1136/bmjopen-2018-025003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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
OBJECTIVE The aim of this study was to identify the social, biological, behavioural and psychological factors related to physical activity (PA) in early pregnancy. DESIGN This is a secondary analysis of data from a prospective cohort study. SETTING The study was conducted in Cork, Ireland. PARTICIPANTS Nulliparous women with singleton pregnancies were recruited and then interviewed at 15±1 weeks' gestation. PRIMARY AND SECONDARY OUTCOMES The biopsychosocial model identified factors including social (age), biological (body mass index), behavioural (diet) and psychological (anxiety) at 15±1 weeks' gestation. PA subgroups were identified based on a latent class analysis of their responses to a set of questions about the amount and intensity of activity they were engaging in during the pregnancy. Associations were estimated with multivariable multinomial logistic regression models. RESULTS From a total of 2579, 1774 (69%) women were recruited; ages ranged from 17 to 45 years. Based on a combination of model fit, theoretical interpretability and classification quality, the latent class analyses identified three PA subgroups: low PA (n=393), moderate PA (n=960) and high PA (n=413). The fully adjusted model suggests non-smokers, and consumers of fruit and vegetables were more likely to be in the high PA subgroup (vs low). Women with more than 12 years of schooling and a higher socioeconomic status were more likely to be in the moderate PA subgroup (vs low). CONCLUSION The findings highlight potential links between PA, a low education level and a low socioeconomic background. These factors should be considered for future interventions to improve low PA levels during pregnancy. TRIAL REGISTRATION NUMBER ACTRN 12607000551493.
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Affiliation(s)
- Caragh Flannery
- School of Psychology, Health Behaviour Change Research Group, National University of Ireland Galway, Galway, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Darren Dahly
- School of Public Health, University College Cork, Cork, Ireland
- Health Research Board, Clinical Research Facility Cork, University College Cork, Cork, Ireland
| | - Molly Byrne
- School of Psychology, Health Behaviour Change Research Group, National University of Ireland Galway, Galway, Ireland
| | - Ali Khashan
- School of Public Health, University College Cork, Cork, Ireland
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Louise C Kenny
- Department of Women’s and Children’s Health, University of Liverpool School of Life Sciences, Liverpool, UK
| | - Fionnuala McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
- National Maternity Hospital, University College Dublin, Dublin, Ireland
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Lafarge C, Rosman S, Ville I. Pregnancy termination for fetal abnormality: Ambivalence at the heart of women's experience. WOMENS STUDIES INTERNATIONAL FORUM 2019. [DOI: 10.1016/j.wsif.2019.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mutiso SK, Murage A, Mwaniki AM. Factors associated with a positive depression screen after a miscarriage. BMC Psychiatry 2019; 19:8. [PMID: 30616554 PMCID: PMC6323848 DOI: 10.1186/s12888-018-1991-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 12/18/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Miscarriages are a common pregnancy complication and positive depression screen after a miscarriage has been shown to be high in our population. Various factors are associated with an increased risk of developing depression after a miscarriage. However, these factors vary across populations studied with no studies existing in our region. We set out to determine the factors associated with a positive depression screen among post-miscarriage women at the Aga Khan University hospital, Nairobi. METHODS Patients were recruited at the 2 weeks clinic review after a miscarriage in the gynaecological clinics. They were screened using the Edinburgh postnatal depression scale for depression after a miscarriage. Analysis was done using Univariate and multivariate analysis to compare clinical variables between the screen - positive and screen - negative women in order to delineate the potential pattern of association between the two among the study subjects. RESULTS Positive depression screen was detected in 34.1% of the patients recruited. Univariate analysis revealed that education level (p = 0.039) and mode of conception (p = 0.005) impacted on the outcome of the depression screen. In multivariate analysis, multiple factors impacted on the depression screen and these included: age (p = 0.009), education level (p = 0.001), gestation at miscarriage (p = 0.04), marital status (p = 0.043), prior miscarriage (p = 0.011) and mode of conception (p = 0.03). CONCLUSION Factors that seem to impact on the positive depression screen include a younger age, low education level, an older gestational age at miscarriage, being single, an assisted mode of conception and prior miscarriage. These factors may be used to triage women after a miscarriage in order to pick up those who may screen positive for depression after a miscarriage.
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Affiliation(s)
- Steve Kyende Mutiso
- Department of Obstetrics and Gynaecology, Aga Khan University hospital, Nairobi, Kenya.
| | - Alfred Murage
- 0000 0004 1756 6158grid.411192.eDepartment of Obstetrics and Gynaecology, Aga Khan University hospital, Nairobi, Kenya
| | - Abraham Mukaindo Mwaniki
- 0000 0004 1756 6158grid.411192.eDepartment of Obstetrics and Gynaecology, Aga Khan University hospital, Nairobi, Kenya
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The Impact of Previous Pregnancy Loss on Lactating Behaviors and Use of Herbal Medicines during Breastfeeding: A Post Hoc Analysis of the Herbal Supplements in Breastfeeding InvesTigation (HaBIT). EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:1035875. [PMID: 30532793 PMCID: PMC6250025 DOI: 10.1155/2018/1035875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/24/2018] [Indexed: 11/18/2022]
Abstract
Introduction Complementary and alternative medicines (CAMs) are commonly used among lactating women, despite the poor knowledge of these products and of their safety. Perception of pregnancy- and breastfeeding-related difficulties and consequent use of CAMs may differ in bereaved women, by force of the distress related to previous loss, although no literature evidence is available. This Herbal supplements in Breastfeeding InvesTigation (HaBIT) post hoc analysis explored the impact of previous pregnancy loss on lactating behaviors and on use of CAMs during breastfeeding. Methods A web-based survey was conducted among lactating women with no previous alive child, resident in Tuscany (Italy). Data on lactating behavior and on CAMs use were collected and evaluated among women with previous pregnancy loss as compared to control women. Results Out of 476 women answering the questionnaire, 233 lactating women with one child were considered. Of them, 80 had history of pregnancy loss. Cesarean birth was significantly more frequent among women with history of pregnancy loss as compared to controls (41% versus 22%; p=0.004). Proportion, length of exclusive breastfeeding, and occurrence of breastfeeding-related complications were comparable among the two cohorts. More than half of women used CAMs during breastfeeding. Use of CAMs was more frequent among women with previous pregnancy loss (54% versus 68%; p=0.050), specifically considering herbal preparations (16% versus 30%; p=0.018). Major advisors for CAMs use were midwives. 18% and 23% of women without and with history of pregnancy loss declared no clear perception on CAMs efficacy and safety. Conclusion Overcoming the social taboo of pregnancy loss and training healthcare professionals for an adequate management of the perinatal period are essential for an effective and safe care. Despite the common use and advice on CAMs use during breastfeeding, it is important to acknowledge that limited evidence supports their safety and efficacy during such critical period.
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Reardon DC. The abortion and mental health controversy: A comprehensive literature review of common ground agreements, disagreements, actionable recommendations, and research opportunities. SAGE Open Med 2018; 6:2050312118807624. [PMID: 30397472 PMCID: PMC6207970 DOI: 10.1177/2050312118807624] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/26/2018] [Indexed: 12/26/2022] Open
Abstract
The abortion and mental health controversy is driven by two different perspectives regarding how best to interpret accepted facts. When interpreting the data, abortion and mental health proponents are inclined to emphasize risks associated with abortion, whereas abortion and mental health minimalists emphasize pre-existing risk factors as the primary explanation for the correlations with more negative outcomes. Still, both sides agree that (a) abortion is consistently associated with elevated rates of mental illness compared to women without a history of abortion; (b) the abortion experience directly contributes to mental health problems for at least some women; (c) there are risk factors, such as pre-existing mental illness, that identify women at greatest risk of mental health problems after an abortion; and (d) it is impossible to conduct research in this field in a manner that can definitively identify the extent to which any mental illnesses following abortion can be reliably attributed to abortion in and of itself. The areas of disagreement, which are more nuanced, are addressed at length. Obstacles in the way of research and further consensus include (a) multiple pathways for abortion and mental health risks, (b) concurrent positive and negative reactions, (c) indeterminate time frames and degrees of reactions, (d) poorly defined terms, (e) multiple factors of causation, and (f) inherent preconceptions based on ideology and disproportionate exposure to different types of women. Recommendations for collaboration include (a) mixed research teams, (b) co-design of national longitudinal prospective studies accessible to any researcher, (c) better adherence to data sharing and re-analysis standards, and (d) attention to a broader list of research questions.
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Zhu X, Li J, Zhu Y, Wang W, Wu X, Yang Y, Gu L, Gu Y, Hu Y. Application of chromosomal microarray analysis in products of miscarriage. Mol Cytogenet 2018; 11:44. [PMID: 30140311 PMCID: PMC6098645 DOI: 10.1186/s13039-018-0396-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/08/2018] [Indexed: 12/20/2022] Open
Abstract
Background Chromosomal abnormality is one of the major cause of spontaneous abortion. Most available guidelines suggest genetic testing after three miscarriages, which has been proved to be difficult to adhere to and somewhat of low cost-effectiveness. As chromosomal microarray analysis has been recommended to be applied on miscarriage products, we managed a retrospective study on our experience investigate the potential impact of this technique on previous guidelines and our present management on miscarried couples and products. Results Of the 405 products of conceptions, the overall detection rate of pathogenetic results was 55.3% (224/405), including 7.1% (16/224) copy number changes which could be missed by conventional karyotyping analysis. Of the 222 natural conception samples, abnormal genetic results were found in 126 cases (56.8%). The detection rate in the assistant reproductive treatment group was 53.6% (98/183). No significant difference was found between these two groups (p = 0.645, OR = 1.110 with 95% CI: 0.713–1.726). The detection rate was 53.2% (75/141) in 141 product-of-conceptions (POCs) of mothers with adverse pregnancy histories. Of the 264 POC samples of mothers without abnormal pregnancy histories, 56.4% (149/264) were genetically abnormal. The detection rate and maternal age between these two groups were all compatible. Conclusions Chromosomal microarray testing should be referred to couples at their first miscarriage regardless of the way how they get pregnant.
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Affiliation(s)
- Xiangyu Zhu
- 1Department of Obstetrics and Gynecology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, 210008 Jiangsu China
| | - Jie Li
- 1Department of Obstetrics and Gynecology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, 210008 Jiangsu China
| | - Yujie Zhu
- 1Department of Obstetrics and Gynecology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, 210008 Jiangsu China
| | - Wanjun Wang
- 1Department of Obstetrics and Gynecology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, 210008 Jiangsu China
| | - Xing Wu
- 1Department of Obstetrics and Gynecology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, 210008 Jiangsu China
| | - Ying Yang
- 1Department of Obstetrics and Gynecology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, 210008 Jiangsu China
| | - Leilei Gu
- 1Department of Obstetrics and Gynecology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, 210008 Jiangsu China
| | - Yuanyuan Gu
- 1Department of Obstetrics and Gynecology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, 210008 Jiangsu China
| | - Yali Hu
- 2Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008 Jiangsu China
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Emotional Effect of the Loss of One or Both Fetuses in a Monochorionic Twin Pregnancy. J Obstet Gynecol Neonatal Nurs 2018; 47:137-145. [DOI: 10.1016/j.jogn.2018.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2018] [Indexed: 10/18/2022] Open
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Mutiso SK, Murage A, Mukaindo AM. Prevalence of positive depression screen among post miscarriage women- A cross sectional study. BMC Psychiatry 2018; 18:32. [PMID: 29402255 PMCID: PMC5799918 DOI: 10.1186/s12888-018-1619-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 01/25/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Miscarriages are a common pregnancy complication affecting about 10-15% of pregnancies. Miscarriages may be associated with a myriad of psychiatric morbidity at various timelines after the event. Depression has been shown to affect about 10-20% of all women following a miscarriage. However, no data exists in the local setting informing on the prevalence of post-miscarriage depression. We set out to determine the prevalence of positive depression screen among women who have experienced a miscarriage at the Aga Khan University hospital, Nairobi. METHODS The study was cross-sectional in design. Patients who had a miscarriage were recruited at the post-miscarriage clinic review at the gynecology clinics at Aga Khan University Hospital, Nairobi. The Edinburgh postpartum depression scale was used to screen for depression in the patients. Prevalence was calculated from the percentage of patients achieving the cut -off score of 13 over the total number of patients. RESULTS A total of 182 patients were recruited for the study. The prevalence of positive depression screen was 34.1% since 62 of the 182 patients had a positive depression screen. Moreover, of the patients who had a positive depression screen, 21(33.1%) had thoughts of self-harm. CONCLUSION A positive depression screen is present in 34.1% of women in our population two weeks after a miscarriage. Thoughts of self-harm are present in about a third of these women (33.1%) hence pointing out the importance of screening these women using the EPDS after a miscarriage.
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Affiliation(s)
- Steve Kyende Mutiso
- Department of Obstetrics and Gynaecology, Aga Khan University hospital, Nairobi, Kenya.
| | - Alfred Murage
- 0000 0004 1756 6158grid.411192.eDepartment of Obstetrics and Gynaecology, Aga Khan University hospital, Nairobi, Kenya
| | - Abraham Mwaniki Mukaindo
- 0000 0004 1756 6158grid.411192.eDepartment of Obstetrics and Gynaecology, Aga Khan University hospital, Nairobi, Kenya
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Emergency department use during pregnancy: a prospective observational study in a single center institution. Arch Gynecol Obstet 2018; 297:1131-1135. [DOI: 10.1007/s00404-018-4684-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 01/23/2018] [Indexed: 10/18/2022]
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Hunter A, Tussis L, MacBeth A. The presence of anxiety, depression and stress in women and their partners during pregnancies following perinatal loss: A meta-analysis. J Affect Disord 2017; 223:153-164. [PMID: 28755623 DOI: 10.1016/j.jad.2017.07.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/15/2017] [Accepted: 07/05/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Research indicates perinatal loss is associated with anxiety, depression and stress in women and partners during subsequent pregnancies. However, there are no robust estimates of anxiety, depression and stress for this group. We meta-analytically estimated rates of anxiety, depression and stress in pregnant women and their partners during pregnancies after previous perinatal loss. METHODS Databases (Medline, PsychInfo, Embase, Cinahl Plus) and grey literature were searched from 1995 through to May 2016. Search terms included: depression, anxiety, or stress with perinatal loss (miscarry*, perinatal death, spontaneous abortion, fetal death, stillbirth, intrauterine death, TOPFA) and subsequent pregnancy. Case-controlled, English-language studies using validated measures of anxiety, depression or stress in women or partners during pregnancy following perinatal loss were included. Data for effect sizes, study and demographic data were extracted. RESULTS We identified nineteen studies representing n = 5114 women with previous loss; n = 30,272 controls; n = 106 partners with previous perinatal loss; and n = 91 control men. Random effects modelling demonstrated significant effects of perinatal loss on anxiety (d = 0.69, 95% CI = 0.41-0.97) and depression (d = 0.22, 95% CI = 0.15-0.30) in women; but no effect on stress (d = - 0.002, 95% CI = - 0.0639 to 0.0605). LIMITATIONS This study was limited by the quality of available studies, underpowered moderator analyses and an inability to examine additional covariates. Insufficient data were available to generate reliable effects for psychological distress in partners. CONCLUSIONS Our findings confirm elevated anxiety and depression levels during pregnancies following perinatal loss. Further research on predictors of distress in women and their partners is required.
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Affiliation(s)
- Amanda Hunter
- Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - Lorena Tussis
- Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - Angus MacBeth
- Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland, UK.
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San Lazaro Campillo I, Meaney S, McNamara K, O'Donoghue K. Psychological and support interventions to reduce levels of stress, anxiety or depression on women's subsequent pregnancy with a history of miscarriage: an empty systematic review. BMJ Open 2017; 7:e017802. [PMID: 28882928 PMCID: PMC5595175 DOI: 10.1136/bmjopen-2017-017802] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE The aim of this systematic review was to assess the effect of interventions to reduce stress in pregnant women with a history of miscarriage. DESIGN A systematic review of randomised controlled trials (RCTs). DATA SOURCE A total of 13 medical, psychological and social electronic databases were searched from January 1995 to April 2016 including PUBMED, CENTRAL, Web of Science and EMBASE. ELIGIBILITY CRITERIA This review focused on women in their subsequent pregnancy following miscarriage. All published RCTs which assessed the effect of non-medical interventions such as counselling or support interventions on psychological and mental health outcomes such as stress, anxiety or depression when compared with a control group were included. Stress, anxiety or depression had to be measured at least preintervention and postintervention. RESULTS This systematic review found no RCT which met our initial inclusion criteria. Of the 4140 titles screened, 17 RCTs were identified. All of them were excluded. One RCT, which implemented a caring-based intervention, included pregnant women in their subsequent pregnancy; however, miscarriage was analysed as a composite variable among other pregnancy losses such as stillbirth and neonatal death. Levels of perceived stress were measured by four RCTs. Different types of non-medical interventions, time of follow-up and small sample sizes were found. CONCLUSION Cohort studies and RCTs in non-pregnant women suggest that support and psychological interventions may improve pregnant women's psychological well-being after miscarriage. This improvement may reduce adverse pregnancy-related outcomes in subsequent pregnancies. However, this review found no RCTs which met our criteria. There is a need for targeted RCTs that can provide reliable and conclusive results to determine effective interventions for this vulnerable group.
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Affiliation(s)
- Indra San Lazaro Campillo
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork - National University of Ireland, Cork, Ireland
| | - Sarah Meaney
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork - National University of Ireland, Cork, Ireland
- National Perinatal Epidemiology Centre (NPEC), University College Cork - National University of Ireland, Cork, Ireland
| | - Karen McNamara
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork - National University of Ireland, Cork, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork - National University of Ireland, Cork, Ireland
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork - National University of Ireland, Cork, Ireland
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Kersting A, Dölemeyer R, Wagner B, Linde K. Abschied am Beginn des Lebens. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0221-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Togher KL, Treacy E, O'Keeffe GW, Kenny LC. Maternal distress in late pregnancy alters obstetric outcomes and the expression of genes important for placental glucocorticoid signalling. Psychiatry Res 2017; 255:17-26. [PMID: 28511050 DOI: 10.1016/j.psychres.2017.05.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 03/13/2017] [Accepted: 05/07/2017] [Indexed: 12/18/2022]
Abstract
The experience of maternal distress in pregnancy is often linked with poorer obstetric outcomes for women as well as adverse outcomes for offspring. Alterations in placental glucocorticoid signalling and subsequent increased fetal exposure to cortisol have been suggested to underlie this relationship. In the current study, 121 pregnant women completed the Perceived Stress Scale, State Trait Anxiety Inventory and Edinburgh Postnatal Depression Scale in the third trimester of pregnancy. Placental samples were collected after delivery. Maternal history of psychiatric illness and miscarriage were significant predictors of poorer mental health in pregnancy. Higher anxiety was associated with an increase in women delivering via elective Caesarean Section, and an increase in bottle-feeding. Birth temperature was mildly reduced among infants of women with high levels of depressive symptomology. Babies of mothers who scored high in all stress (cumulative distress) measures had reduced 5-min Apgar scores. High cumulative distress reduced the expression of placental HSD11B2 mRNA and increased the expression of placental NR3C1 mRNA. These data support a role for prenatal distress as a risk factor for altered obstetric outcomes. The alterations in placental gene expression support a role for altered placental glucocorticoid signalling in the relationship between maternal prenatal distress and adverse outcomes.
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Affiliation(s)
- Katie L Togher
- Irish Centre for Fetal and Neonatal Translation Research (INFANT), Cork University Maternity Hospital, University College Cork, Cork, Ireland; Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Cork, Ireland; Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Eimear Treacy
- Irish Centre for Fetal and Neonatal Translation Research (INFANT), Cork University Maternity Hospital, University College Cork, Cork, Ireland; Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Cork, Ireland; Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Gerard W O'Keeffe
- Irish Centre for Fetal and Neonatal Translation Research (INFANT), Cork University Maternity Hospital, University College Cork, Cork, Ireland; Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland.
| | - Louise C Kenny
- Irish Centre for Fetal and Neonatal Translation Research (INFANT), Cork University Maternity Hospital, University College Cork, Cork, Ireland; Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Cork, Ireland.
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Devlin CA, Huberty J, Downs DS. Influences of prior miscarriage and weight status on perinatal psychological well-being, exercise motivation and behavior. Midwifery 2016; 43:29-36. [PMID: 27838526 PMCID: PMC5314732 DOI: 10.1016/j.midw.2016.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 09/28/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES women who have experienced miscarriage may be at increased risk for elevated depressive and anxiety symptoms in subsequent pregnancies. Exercise may be a useful strategy for coping with these symptoms. Little is known about how miscarriage influences prenatal exercise behavior. The study purpose was to examine the influences of miscarriage history and prepregnancy weight status on pregnant women's psychological health, exercise motivation, and behavior using the Theory of Planned Behavior. PARTICIPANTS/SETTING Pregnant women (N=203; 41 with prior miscarriage; 72 overweight/obese; BMI > 25.0) in the northeast United States. DESIGN Women prospectively reported their depressive/anxiety symptoms and exercise motivation/behavior in the 1st, 2nd, and 3rd trimesters via mailed surveys. Group differences in depressive/anxiety symptoms, exercise behavior, and its motivational determinants were examined using Chi Square analyses and Univariate and Multivariate Analyses of Covariance. MEASUREMENTS AND FINDINGS Women with a history of miscarriage had higher 1st and 2nd trimester depressive/anxiety symptoms and lower 1st trimester attitudes about exercise and 1st and 2nd trimester perceived behavior control than women without a history of miscarriage. Overweight/obese women had higher 1st and 2nd trimester pregnancy depressive/anxiety symptoms, engaged in less prepregnancy exercise, and had lower levels of exercise intention, attitude, and perceived behavior control throughout pregnancy than normal weight women. KEY CONCLUSIONS Women with a history of miscarriage and overweight/obese women have poorer psychological health and lower motivation to exercise during pregnancy than women without a history of miscarriage and normal weight women. IMPLICATIONS FOR PRACTITIONERS Interventions and healthcare provider communications aimed at promoting perinatal exercise behavior and psychological health should take into account pre-pregnancy weight status and pregnancy history to identify strategies to help women, particularly overweight/obese women with a history of miscarriage, to overcome exercise barriers.
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Affiliation(s)
- Courtenay A Devlin
- Exercise Psychology Laboratory, Department of Kinesiology, Penn State University, University Park, PA, USA.
| | - Jennifer Huberty
- Department of Exercise Science & Health, School of Nutrition Health and Promotion, Arizona State University, Phoenix, AZ, USA
| | - Danielle Symons Downs
- Exercise Psychology Laboratory, Department of Kinesiology, Penn State University, University Park, PA, USA; Department of OBGYN, Hershey Medical Center, Hershey, PA, USA
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Abbaspoor Z, Razmju PS, Hekmat K. Relation between quality of life and mental health in pregnant women with prior pregnancy loss. J Obstet Gynaecol Res 2016; 42:1290-1296. [PMID: 27436045 DOI: 10.1111/jog.13061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/12/2016] [Accepted: 04/09/2016] [Indexed: 11/30/2022]
Abstract
AIM This paper intends to compare quality of life (QoL) and mental health among pregnant women with and without previous pregnancy loss. METHODS An analytical cross-sectional study was conducted on 409 women between the 16th and 30th weeks of gestation in health centers in Ahvaz, Iran, including 145 women with prior pregnancy loss (group 1) and 264 women without such history (group 2). Data were collected using the QoL Short Form-36 questionnaire, the Mental Health Questionnaire 25 and a questionnaire for assessing sociodemographic variables. Data were analyzed using spss version 22. Results were analyzed using the χ2 -test, the Student's t-test and logistic regression. P < 0.05 was defined as statistically significant. RESULTS There was a significant difference between the two groups in respect to QoL and mental health. Women with previous pregnancy loss had lower scores in total and in all subscales of the QoL Short Form-36 (P < 0.001) and higher scores in total and in six out of the nine subscales of the Mental Health Questionnaire 25 compared to women without these histories. CONCLUSION Women with history of spontaneous abortion and stillbirth seem to have poorer QoL and mental health during their subsequent pregnancy than those without such experience.
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Affiliation(s)
- Zahra Abbaspoor
- Department of Midwifery, Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Islamic Republic of Iran
| | - Parvanah Sarparast Razmju
- Department of Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Islamic Republic of Iran
| | - Kadijah Hekmat
- Department of Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Islamic Republic of Iran.
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Abstract
Infertility and perinatal loss are common, and associated with lower quality of life, marital discord, complicated grief, major depressive disorder, anxiety disorders, and post-traumatic stress disorder. Young women, who lack social supports, have experienced recurrent pregnancy loss or a history of trauma and / or preexisting psychiatric illness are at a higher risk of experiencing psychiatric illnesses or symptoms after a perinatal loss or during infertility. It is especially important to detect, assess, and treat depression, anxiety, or other psychiatric symptoms because infertility or perinatal loss may be caused or perpetuated by such symptoms. Screening, psychoeducation, provision of resources and referrals, and an opportunity to discuss their loss and plan for future pregnancies can facilitate addressing mental health concerns that arise. Women at risk of or who are currently experiencing psychiatric symptoms should receive a comprehensive treatment plan that includes the following: (1) proactive clinical monitoring, (2) evidence-based approaches to psychotherapy, and (3) discussion of risks, benefits, and alternatives of medication treatment during preconception and pregnancy.
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Affiliation(s)
- Amritha Bhat
- Department of Psychiatry, University of Washington, Box 35650, Seattle, WA, 98195, USA.
| | - Nancy Byatt
- Departments of Psychiatry and Obstetrics and Gynecology, UMass Medical School, Worcester, MA, USA
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