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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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Kuhlmann E, Scharli P, Schick M, Ditzen B, Langer L, Strowitzki T, Wischmann T, Kuon RJ. The Posttraumatic Impact of Recurrent Pregnancy Loss in Both Women and Men. Geburtshilfe Frauenheilkd 2023; 83:88-96. [PMID: 36643876 PMCID: PMC9835763 DOI: 10.1055/a-1916-9180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/02/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Recurrent pregnancy loss is usually associated with significant psychological distress for both partners of the couple. It may act as a traumatic experience resulting in a posttraumatic stress disorder. The object of this study is to examine the posttraumatic impact of recurrent pregnancy loss on men and women and their interdependencies. Methods Cross-sectional study. All couples referred to the special unit for recurrent pregnancy loss between March 2019 and October 2020 were asked to participate with a sample size of 105 couples and 17 women. They were invited to complete a questionnaire package estimating the prevalence of posttraumatic stress, with anxiety, depression, lack of social support and dysfunctional coping strategies as contributing risk factors. Couple data were analysed with the Actor Partner Interdependence Model, taking the couple as a dyad. Results The response rate was 82.3 percent, with posttraumatic stress being measured in 13.7% of the women versus 3.9% of the men (p = 0.017). For women, number of curettages, controlled for the number of losses, correlated with the severity of posttraumatic stress (p < 0.05). Higher levels of anxiety, depression and lack of social support in women correlated positively with posttraumatic stress in their partners. The men's coping strategy "trivialization and wishful thinking" as well as "avoidance" correlated with more severe posttraumatic stress in the female partners (both p < 0.05). Conclusion The posttraumatic risks within a couple with recurrent pregnancy loss are interdependent. Recurrent pregnancy loss clinics should assess posttraumatic risks of both partners in their routine diagnostic process.
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Affiliation(s)
- Emily Kuhlmann
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany,Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany
| | - Pauline Scharli
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany,Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany
| | - Maren Schick
- Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany,Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany,Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Laila Langer
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany
| | - Thomas Strowitzki
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany
| | - Tewes Wischmann
- Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany
| | - Ruben-J. Kuon
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany,Korrespondenzadresse Prof. Dr. Ruben-J. Kuon Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s HospitalIm Neuenheimer Feld 44069120 HeidelbergGermany
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Harty T, Trench M, Keegan O, O'Donoghue K, Nuzum D. The experiences of men following recurrent miscarriage in an Irish tertiary hospital: A qualitative analysis. Health Expect 2022; 25:1048-1057. [PMID: 35243718 PMCID: PMC9122424 DOI: 10.1111/hex.13452] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Miscarriage is one of the most common complications of pregnancy, and recurrent miscarriage affects approximately 1% of couples. The psychological impact of early pregnancy loss on women has been well documented in the literature; however, the burden of miscarriage on men remains largely unexplored. Methods This qualitative research involved semi‐structured interviews with five men whose partners had experienced at least two consecutive miscarriages. Participants were recruited through an early pregnancy loss clinic in a large, tertiary maternity hospital. Interviews were recorded and transcribed verbatim and analysed thematically. Results Recurrent miscarriage had a pronounced psychological impact on all the men interviewed, which worsened with each successive miscarriage. Three primary themes were developed from the data: (1) the deeply emotional experiences of men following recurrent miscarriage; (2) frustrations experienced during the provision of support following recurrent miscarriage; and (3) a sense of feeling unimportant. Lack of timely provision of information about miscarriage as well as lack of access to services were highlighted as deficiencies in the quality of care provided after recurrent miscarriage. Conclusion The experiences of men after recurrent miscarriage are based largely on their assumed role as the protector and supporter of their partner, which often results in neglect of their own psychological needs. The support required by men is similar to that required by women, and greater access to information and services is needed to improve the experiences of men following recurrent miscarriage. Patient Contribution Participants were recruited through the Pregnancy Loss Clinic at Cork University Maternity Hospital and were identified by specialist midwives. Participants were approached and interviewed by one of the researchers. Participation was voluntary and the men received no financial contribution for their time.
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Affiliation(s)
- Tommy Harty
- Department of Medicine, Cork University Hospital, Cork, Ireland.,Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Maria Trench
- Graduate School of Healthcare Management, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Orla Keegan
- Graduate School of Healthcare Management, Royal College of Surgeons Ireland, Dublin, Ireland.,Department of Education and Bereavement, Irish Hospice Foundation, Dublin, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.,Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland.,The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
| | - Daniel Nuzum
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.,Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
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Hiefner AR, Villareal A. A Multidisciplinary, Family-Oriented Approach to Caring for Parents After Miscarriage: The Integrated Behavioral Health Model of Care. Front Public Health 2021; 9:725762. [PMID: 34917568 PMCID: PMC8669268 DOI: 10.3389/fpubh.2021.725762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022] Open
Abstract
Miscarriage is increasingly gaining recognition, both in scientific literature and media outlets, as a loss that has significant and lasting effects on parents, though often disenfranchised and overlooked by both personal support networks and healthcare providers. For both men and women, miscarriage can usher in intense grief, despair, and difficulty coping, and for women in particular, there is evidence of increased prevalence of depression, anxiety, and post-traumatic stress. Additionally, miscarriage can contribute to decreased relationship satisfaction and increased risk of separation, all while stigma and disenfranchisement create a sense of isolation. Despite this increased need for support, research indicates that many parents experience their healthcare providers as dismissive of the significance of the loss and as primarily focusing only on the physical elements of care. Research exploring the barriers to providers engaging in more biopsychosocial-oriented care has identified time constraints, lack of resources, lack of training in addressing loss, and compassion fatigue as key areas for intervention. This paper will review the biopsychosocial elements of miscarriage and discuss a multidisciplinary, family-oriented approach that can be implemented in healthcare settings to ensure a high quality and holistic level of care for individuals, couples, and families experiencing pregnancy loss.
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Affiliation(s)
- Angela R Hiefner
- Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Astrud Villareal
- Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
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5
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du Fossé NA, Lashley EELO, Treurniet TT, van Lith JMM, le Cessie S, Boosman H, van der Hoorn MLP. Exploring gender differences among couples with unexplained recurrent pregnancy loss regarding preferences for supportive care. BMC Pregnancy Childbirth 2021; 21:796. [PMID: 34847864 PMCID: PMC8630871 DOI: 10.1186/s12884-021-04277-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 11/16/2021] [Indexed: 12/01/2022] Open
Abstract
Background International guidelines recommend to offer supportive care during a next pregnancy to couples affected by recurrent pregnancy loss (RPL). In previous research, several options for supportive care have been identified and women’s preferences have been quantified. Although it is known that RPL impacts the mental health of both partners, male preferences for supportive care have hardly been explored. Methods A cross-sectional study was conducted in couples who visited a specialized RPL clinic in the Netherlands between November 2018 and December 2019. Both members of the couples received a questionnaire that quantified their preferences for supportive care in a next pregnancy and they were asked to complete this independently from each other. Preferences for each supportive care option were analysed on a group level (by gender) and on a couple level, by comparing preferences of both partners. Results Ninety-two questionnaires (completed by 46 couples) were analysed. The overall need for supportive care indicated on a scale from 1 to 10 was 6.8 for men and 7.9 for women (P = 0.002). Both genders preferred to regularly see the same doctor with knowledge of their obstetric history, to make a plan for the first trimester and to have frequent ultrasound examinations. A lower proportion of men preferred a doctor that shows understanding (80% of men vs. 100% of women, P = 0.004) and a doctor that informs on wellbeing (72% vs. 100%, P = ≤0.000). Fewer men preferred support from friends (48% vs. 74%, P = 0.017). Thirty-seven percent of men requested more involvement of the male partner at the outpatient clinic, compared to 70% of women (P = 0.007). In 28% of couples, partners had opposing preferences regarding peer support. Conclusions While both women and men affected by RPL are in need of supportive care, their preferences may differ. Current supportive care services may not entirely address the needs of men. Health care professionals should focus on both partners and development of novel supportive care programs with specific attention for men should be considered. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04277-4.
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Affiliation(s)
- N A du Fossé
- Department of Gynecology and Obstetrics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands. .,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, 2333 ZA, the Netherlands.
| | - E E L O Lashley
- Department of Gynecology and Obstetrics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
| | - T T Treurniet
- Department of Gynecology and Obstetrics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
| | - J M M van Lith
- Department of Gynecology and Obstetrics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
| | - S le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, 2333 ZA, the Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, 2333 ZA, the Netherlands
| | - H Boosman
- Department of Quality and Patient Safety, Leiden University Medical Center, Leiden, 2333 ZA, the Netherlands
| | - M L P van der Hoorn
- Department of Gynecology and Obstetrics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
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6
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Iqbal Z, Jilanee SDA, Uppada LP, Imtiaz S, Khan H, Shah SMH, Tousif S, Rahim A. Evaluating the Clinical Risk Factors Associated With Miscarriages in Women in Karachi, Pakistan. Cureus 2021; 13:e19057. [PMID: 34824942 PMCID: PMC8610211 DOI: 10.7759/cureus.19057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Spontaneous pregnancy loss is unquestionably common worldwide, with roughly 5% of pregnancies ending in this way. Miscarriage can lead to serious psychological issues for women as well as their mothers. Although, it is irreversible but can be prevented through proper risk assessment of women. The goal of this study is to find clinical predictors of miscarriages in Karachi, Pakistani women. Methodology The study is a retrospective chart review that used data of women having livebirth and miscarriages at the Liaquat National Hospital Karachi Pakistan. Data of a total of 517 women were included in the study, out of which 453 have had a live birth, and 64 had miscarriages. To determine the factors associated with miscarriages, multivariable logistic regression was used. Results The mean age of women was 31.08 (±5.10) years. Age of mother over 40 years (adjusted odds ratio [AOR]=10.28; p-value=0.001), overweight and obesity (AOR=3.01; p-value=0.001) and history of miscarriage (AOR=2.91; p-value=0.003) are variables significantly associated with miscarriages. Conclusion Findings of the current study shown that risk factors of miscarriages included age of mother, increased BMI and previous history of miscarriages. All these factors need to be considered while providing antenatal care to mothers to mitigate the risk of miscarriages.
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Affiliation(s)
- Zafar Iqbal
- Emergency Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
- Emergency Department, The Kidney Center, Karachi, PAK
| | | | | | - Samahir Imtiaz
- Medical College, Liaquat National Hospital and Medical College, Karachi, PAK
| | | | | | - Sohaib Tousif
- Medical School, Ziauddin Medical University, Karachi, PAK
| | - Anum Rahim
- Indus Hospital Research Center, The Indus Hospital, Karachi, PAK
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7
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Okeke Ogwulu CB, Williams EV, Chu JJ, Devall AJ, Beeson LE, Hardy P, Cheed V, Yongzhong S, Jones LL, La Fontaine Papadopoulos JH, Bender-Atik R, Brewin J, Hinshaw K, Choudhary M, Ahmed A, Naftalin J, Nunes N, Oliver A, Izzat F, Bhatia K, Hassan I, Jeve Y, Hamilton J, Debs S, Bottomley C, Ross J, Watkins L, Underwood M, Cheong Y, Kumar CS, Gupta P, Small R, Pringle S, Hodge FS, Shahid A, Horne AW, Quenby S, Gallos ID, Coomarasamy A, Roberts TE. Cost-effectiveness of mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage: an economic evaluation based on the MifeMiso trial. BJOG 2021; 128:1534-1545. [PMID: 33969614 DOI: 10.1111/1471-0528.16737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of mifepristone and misoprostol (MifeMiso) compared with misoprostol only for the medical management of a missed miscarriage. DESIGN Within-trial economic evaluation and model-based analysis to set the findings in the context of the wider economic evidence for a range of comparators. Incremental costs and outcomes were calculated using nonparametric bootstrapping and reported using cost-effectiveness acceptability curves. Analyses were performed from the perspective of the UK's National Health Service (NHS). SETTING Twenty-eight UK NHS early pregnancy units. SAMPLE A cohort of 711 women aged 16-39 years with ultrasound evidence of a missed miscarriage. METHODS Treatment with mifepristone and misoprostol or with matched placebo and misoprostol tablets. MAIN OUTCOME MEASURES Cost per additional successfully managed miscarriage and quality-adjusted life years (QALYs). RESULTS For the within-trial analysis, MifeMiso intervention resulted in an absolute effect difference of 6.6% (95% CI 0.7-12.5%) per successfully managed miscarriage and a QALYs difference of 0.04% (95% CI -0.01 to 0.1%). The average cost per successfully managed miscarriage was lower in the MifeMiso arm than in the placebo and misoprostol arm, with a cost saving of £182 (95% CI £26-£338). Hence, the MifeMiso intervention dominated the use of misoprostol alone. The model-based analysis showed that the MifeMiso intervention is preferable, compared with expectant management, and this is the current medical management strategy. However, the model-based evidence suggests that the intervention is a less effective but less costly strategy than surgical management. CONCLUSIONS The within-trial analysis found that based on cost-effectiveness grounds, the MifeMiso intervention is likely to be recommended by decision makers for the medical management of women presenting with a missed miscarriage. TWEETABLE ABSTRACT The combination of mifepristone and misoprostol is more effective and less costly than misoprostol alone for the management of missed miscarriages.
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Affiliation(s)
- C B Okeke Ogwulu
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - E V Williams
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - J J Chu
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - A J Devall
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - L E Beeson
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - P Hardy
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - V Cheed
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - S Yongzhong
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - L L Jones
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - J H La Fontaine Papadopoulos
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | | | - K Hinshaw
- Sunderland Royal Hospital, South Tyneside & Sunderland NHS Foundation Trust, Sunderland, UK
| | - M Choudhary
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - A Ahmed
- Sunderland Royal Hospital, South Tyneside & Sunderland NHS Foundation Trust, Sunderland, UK
| | - J Naftalin
- University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - N Nunes
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Isleworth, UK
| | - A Oliver
- St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - F Izzat
- University Hospital Coventry, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - K Bhatia
- Burnley General Hospital, East Lancashire Hospitals NHS Trust, Burnley, UK
| | - I Hassan
- Birmingham Women's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Y Jeve
- Birmingham Women's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - J Hamilton
- Guy's and St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - S Debs
- Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C Bottomley
- University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - J Ross
- Kings College Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - L Watkins
- Liverpool Women's Hospital, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - M Underwood
- Princess Royal Hospital, Shrewsbury and Telford Hospital NHS Trust, Telford, UK
| | - Y Cheong
- Department of Reproductive Medicine, University of Southampton, Southampton, UK
| | - C S Kumar
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - P Gupta
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Small
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Pringle
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - F S Hodge
- Singleton Hospital, Swansea Bay University Health Board, Swansea, UK
| | - A Shahid
- Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - A W Horne
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - S Quenby
- The Biomedical Research Unit in Reproductive Health, University of Warwick, Warwick, UK
| | - I D Gallos
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - A Coomarasamy
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - T E Roberts
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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8
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Farren J, Jalmbrant M, Falconieri N, Mitchell-Jones N, Bobdiwala S, Al-Memar M, Tapp S, Van Calster B, Wynants L, Timmerman D, Bourne T. Differences in post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy between women and their partners: multicenter prospective cohort study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:141-148. [PMID: 33032364 DOI: 10.1002/uog.23147] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/04/2020] [Accepted: 10/04/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To investigate and compare post-traumatic stress (PTS), depression and anxiety in women and their partners over a 9-month period following miscarriage or ectopic pregnancy. METHODS This was a prospective cohort study. Consecutive women and their partners were approached in the early pregnancy units of three hospitals in central London. At 1, 3 and 9 months after early pregnancy loss, recruits were e-mailed links to surveys containing the Hospital Anxiety and Depression Scale and the Post-traumatic Stress Diagnostic Scale. The proportion of participants meeting the screening criteria for moderate or severe anxiety or depression and PTS was assessed. Mixed-effects logistic regression was used to analyze differences between women and their partners and their evolution over time. RESULTS In total, 386 partners were approached after the woman in whom the early pregnancy loss had been diagnosed consented to participate, and 192 couples were recruited. All partners were male. Response rates were 60%, 48% and 39% for partners and 78%, 70% and 59% for women, at 1, 3 and 9 months, respectively. Of the partners, 7% met the criteria for PTS at 1 month, 8% at 3 months and 4% at 9 months, compared with 34%, 26% and 21% of women, respectively. Partners also experienced lower rates of moderate/severe anxiety (6% vs 30% at 1 month, 9% vs 25% at 3 months and 6% vs 22% at 9 months) and moderate/severe depression (2% vs 10% at 1 month, 5% vs 8% at 3 months and 1% vs 7% at 9 months). The odds ratios for psychological morbidity in partners vs women after 1 month were 0.02 (95% CI, 0.004-0.12) for PTS, 0.05 (95% CI, 0.01-0.19) for moderate/severe anxiety and 0.15 (95% CI, 0.02-0.96) for moderate/severe depression. Morbidity for each outcome decreased modestly over time, without strong evidence of a different evolution between women and their partners. CONCLUSIONS Some partners report clinically relevant levels of PTS, anxiety and depression after pregnancy loss, though to a far lesser extent than women physically experiencing the loss. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J Farren
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
- Department of Obstetrics and Gynaecology, Imperial College Healthcare Trust, London, UK
| | - M Jalmbrant
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - N Falconieri
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
| | - N Mitchell-Jones
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
- Department of Obstetrics and Gynaecology, Imperial College Healthcare Trust, London, UK
- Department of Obstetrics and Gynaecology, Chelsea and Westminster NHS Trust, London, UK
| | - S Bobdiwala
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
- Department of Obstetrics and Gynaecology, Imperial College Healthcare Trust, London, UK
| | - M Al-Memar
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
- Department of Obstetrics and Gynaecology, Imperial College Healthcare Trust, London, UK
| | - S Tapp
- Department of Obstetrics and Gynaecology, Imperial College Healthcare Trust, London, UK
| | - B Van Calster
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
- Department of Biomedical Data Sciences, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
- EPI-centre, KU Leuven, Leuven, Belgium
| | - L Wynants
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
- EPI-centre, KU Leuven, Leuven, Belgium
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - D Timmerman
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - T Bourne
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
- Department of Obstetrics and Gynaecology, Imperial College Healthcare Trust, London, UK
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
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9
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Horstman HK, Holman A, McBride MC. Men's Use of Metaphors to Make Sense of Their Spouse's Miscarriage: Expanding the Communicated Sense-Making Model. HEALTH COMMUNICATION 2020; 35:538-547. [PMID: 30706735 DOI: 10.1080/10410236.2019.1570430] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
With approximately 20 % of pregnancies ending in loss, miscarriage is a relatively common and stressful occurrence. Because romantic partners' coping efforts are intimately connected, the way one partner copes with the other's miscarriage has important implications for individual and relational well-being. Grounded in the communicated sense-making (CSM) model, the current study investigated how cis-gender men in heterosexual marriages (n = 45) communicatively constructed the meaning of their wife's miscarriage through metaphors. Analysis of interview data revealed two supra-themes-metaphors of miscarriage and metaphors of men's role as a husband. Metaphors of lost gift, cataclysm, death of a loved one, emptiness, and chaotic movement animated husbands' CSM about their wife's miscarriage. Men drew upon discourses of masculinity to make sense of their role as a husband in the miscarriage process as a rock, guard, repair man, and secondary character. We explore these findings in light of the master narrative of birth and propose an expansion of the CSM model to include metaphors as a key CSM device.
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Affiliation(s)
| | - Amanda Holman
- Department of Communication Studies, Creighton University
| | - M Chad McBride
- Department of Communication Studies, Creighton University
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10
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Okeke Ogwulu CB, Goranitis I, Devall AJ, Cheed V, Gallos ID, Middleton LJ, Harb HM, Williams HM, Eapen A, Daniels JP, Ahmed A, Bender-Atik R, Bhatia K, Bottomley C, Brewin J, Choudhary M, Deb S, Duncan WC, Ewer AK, Hinshaw K, Holland T, Izzat F, Johns J, Lumsden M, Manda P, Norman JE, Nunes N, Overton CE, Kriedt K, Quenby S, Rao S, Ross J, Shahid A, Underwood M, Vaithilingham N, Watkins L, Wykes C, Horne AW, Jurkovic D, Coomarasamy A, Roberts TE. The cost-effectiveness of progesterone in preventing miscarriages in women with early pregnancy bleeding: an economic evaluation based on the PRISM trial. BJOG 2020; 127:757-767. [PMID: 32003141 PMCID: PMC7187468 DOI: 10.1111/1471-0528.16068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess the cost-effectiveness of progesterone compared with placebo in preventing pregnancy loss in women with early pregnancy vaginal bleeding. DESIGN Economic evaluation alongside a large multi-centre randomised placebo-controlled trial. SETTING Forty-eight UK NHS early pregnancy units. POPULATION Four thousand one hundred and fifty-three women aged 16-39 years with bleeding in early pregnancy and ultrasound evidence of an intrauterine sac. METHODS An incremental cost-effectiveness analysis was performed from National Health Service (NHS) and NHS and Personal Social Services perspectives. Subgroup analyses were carried out on women with one or more and three or more previous miscarriages. MAIN OUTCOME MEASURES Cost per additional live birth at ≥34 weeks of gestation. RESULTS Progesterone intervention led to an effect difference of 0.022 (95% CI -0.004 to 0.050) in the trial. The mean cost per woman in the progesterone group was £76 (95% CI -£559 to £711) more than the mean cost in the placebo group. The incremental cost-effectiveness ratio for progesterone compared with placebo was £3305 per additional live birth. For women with at least one previous miscarriage, progesterone was more effective than placebo with an effect difference of 0.055 (95% CI 0.014-0.096) and this was associated with a cost saving of £322 (95% CI -£1318 to £673). CONCLUSIONS The results suggest that progesterone is associated with a small positive impact and a small additional cost. Both subgroup analyses were more favourable, especially for women who had one or more previous miscarriages. Given available evidence, progesterone is likely to be a cost-effective intervention, particularly for women with previous miscarriage(s). TWEETABLE ABSTRACT Progesterone treatment is likely to be cost-effective in women with early pregnancy bleeding and a history of miscarriage.
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Affiliation(s)
- C B Okeke Ogwulu
- Health Economics Unit, College of Medical and Dental Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - I Goranitis
- Health Economics Unit, College of Medical and Dental Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
| | - A J Devall
- College of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - V Cheed
- College of Medical and Dental Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - I D Gallos
- College of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - L J Middleton
- College of Medical and Dental Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - H M Harb
- College of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - H M Williams
- College of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - A Eapen
- Carver College of Medicine, University of Iowa Health Care, Iowa City, IA, USA
| | - J P Daniels
- Faculty of Medicine & Health Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - A Ahmed
- Sunderland Royal Hospital, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
| | | | - K Bhatia
- Burnley General Hospital, East Lancashire Hospitals NHS Trust, Burnley, UK
| | - C Bottomley
- University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - M Choudhary
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - S Deb
- Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - W C Duncan
- MRC Centre for Reproductive Health, the Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - A K Ewer
- College of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - K Hinshaw
- Sunderland Royal Hospital, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
| | - T Holland
- Guy's and St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - F Izzat
- University Hospital Coventry, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - J Johns
- Kings College Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - M Lumsden
- Academic Unit of Reproductive and Maternal Medicine, University of Glasgow, Glasgow, UK
| | - P Manda
- James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - J E Norman
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - N Nunes
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Isleworth, UK
| | - C E Overton
- St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - K Kriedt
- University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - S Quenby
- Biomedical Research Unit in Reproductive Health, University of Warwick, Warwick, UK
| | - S Rao
- Whiston Hospital, St Helen's and Knowsley Teaching Hospitals NHS Trust, Whiston, Prescot, UK
| | - J Ross
- Academic Unit of Reproductive and Maternal Medicine, University of Glasgow, Glasgow, UK
| | - A Shahid
- Whipps Cross Hospital, Barts Health NHS Trust, Leytonstone, London, UK
| | - M Underwood
- Princess Royal Hospital, Shrewsbury and Telford Hospital NHS Trust, Apley, Telford, UK
| | - N Vaithilingham
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Cosham, Portsmouth, UK
| | - L Watkins
- Liverpool Women's Hospital, Liverpool Women's NHS Foundation Trust, Liverpool Women's Hospital, Liverpool, UK
| | - C Wykes
- East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - A W Horne
- MRC Centre for Reproductive Health, the Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - D Jurkovic
- University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - A Coomarasamy
- College of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - T E Roberts
- Health Economics Unit, College of Medical and Dental Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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11
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Chen SL, Chang SM, Kuo PL, Chen CH. Stress, anxiety and depression perceived by couples with recurrent miscarriage. Int J Nurs Pract 2019; 26:e12796. [PMID: 31713284 DOI: 10.1111/ijn.12796] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 06/25/2019] [Accepted: 09/22/2019] [Indexed: 11/29/2022]
Abstract
AIM Recurrent miscarriage is considered a major life event. The main purposes of this study were to compare the differences in stress, anxiety, social support, sleep quality and depressive symptoms in couples experiencing recurrent miscarriage compared to peers who experience full-term normal childbirth in southern Taiwan. METHODS Convenience sampling and snowball sampling were used respectively to recruit 78 couples with and 80 couples without recurrent miscarriage from October 2014 to July 2015. Five structured questionnaires including Perceived Stress Scale, State- Anxiety Inventory, Interpersonal Support Evaluation List, Pittsburgh Sleep Quality Index and Edinburgh Depression Scale were administered. RESULTS Women who experienced recurrent miscarriage perceived significantly higher levels of stress, anxiety and depressive symptoms than their husbands. Women in the recurrent miscarriage group reported significantly greater depressive symptoms than women of the other group. A stepwise multiple regression analysis indicated key predictors of depressive symptoms among women of childbearing age, accounting for 62.9% of the variance, were anxiety, stress, social support and history of recurrent miscarriage. CONCLUSION Women with recurrent miscarriage suffer mild to moderate depressive symptoms and a greater incidence of depression than their peers who experienced normal childbirth. Health professionals can use the knowledge gained from these findings to evaluate women with recurrent miscarriage for stress, anxiety and depressive symptoms and develop supportive interventions.
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Affiliation(s)
- Shu-Lan Chen
- Department of Nursing, Fooyin University, Kaohsiung, Taiwan
| | - Shao-Min Chang
- Department of Nursing, Fooyin University, Kaohsiung, Taiwan
| | - Pao-Lin Kuo
- Department of Obstetrics and Gynecology, College of Medicine, National Cheng-Kung University, Tainan, Taiwan
| | - Chung-Hey Chen
- Department of Nursing, HungKuang University, Taichung, Taiwan.,Department of Nursing & Institute of Allied Health Sciences, National Cheng Kung University, Tainan, Taiwan
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12
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Obst KL, Due C. Men's grief and support following pregnancy loss: A qualitative investigation of service providers' perspectives. DEATH STUDIES 2019; 45:772-780. [PMID: 31709921 DOI: 10.1080/07481187.2019.1688430] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study explores service providers' experiences of supporting men following a miscarriage or stillbirth in Australia. In-depth, semi-structured interviews were completed with seven service providers including midwives, grief counselors and social workers. Participants highlighted that, despite the individual nature of men's grief, there is a need to recognize and address the additional expectations and responsibilities that may compound their experience. Within an environment focused on woman-centered care, participants described creative strategies and inclusive language to promote engagement of men. Further research exploring men's grief is needed to inform training and guidelines for healthcare professionals who work with bereaved families.
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Affiliation(s)
- Kate Louise Obst
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Clemence Due
- School of Psychology, University of Adelaide, Adelaide, Australia
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13
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Nguyen BT, Chang EJ, Bendikson KA. Advanced paternal age and the risk of spontaneous abortion: an analysis of the combined 2011-2013 and 2013-2015 National Survey of Family Growth. Am J Obstet Gynecol 2019; 221:476.e1-476.e7. [PMID: 31128112 DOI: 10.1016/j.ajog.2019.05.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/08/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Maternal and paternal age at first birth are increasing across the global population. Spontaneous abortion, one of the most common abnormal pregnancy outcomes, is known to occur more frequently with increasing maternal age. However, the relationship of advanced paternal age and spontaneous abortion is poorly understood, and previous results have yielded conflicting results. OBJECTIVE To examine the influence of paternal age on the risk of spontaneous abortion among singleton pregnancies conceived without assisted reproductive technologies. MATERIALS AND METHODS This was a retrospective, case-control study using combined pregnancy data from the Centers for Disease Control and Prevention's 2011-2013 and 2013-2015 National Survey of Family Growth. Spontaneous, singleton pregnancy data from women aged 15-45 years were analyzed. Ongoing pregnancies, induced abortions, ectopic pregnancies, preterm births, and intrauterine fetal deaths were excluded. Bivariate associations of pregnancy outcome (spontaneous abortion at <20 weeks and ≤12 weeks vs. live birth at ≥37 weeks) and paternal age were determined, along with those of maternal age and selected demographic and pregnancy characteristics. Significant associations were included in a multivariable logistic regression, which accounted for multiple pregnancies derived from the same respondent. RESULTS A total of 12,710 pregnancies from 6979 women were analyzed, consisting of 2300 (18.2%) spontaneous abortions and 10,410 (81.8%) term live births. Median maternal and paternal ages were 25 and 28 years, respectively. After adjusting for maternal age, race/ethnicity, socioeconomic status, marital status, and pregnancy intention, pregnancies resulting in spontaneous abortions had 2.05 (95% confidence interval, 1.06-2.20) times the odds of being from a father aged 50 years or older, vs. 25-29 years of age. These relationships remained significant when defining SABs at ≤12 weeks (adjusted odds ratio, 2.30; 95% confidence interval, 1.17-4.52). CONCLUSION Paternal age may increase the odds of spontaneous abortion, independent of selected factors, including demographics, pregnancy intention, and maternal age. This association was robust across several gestational age-based definitions of spontaneous abortion, even after adjustment.
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14
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Asri H, Mousannif H, Al Moatassime H. Big Data Analytics in Healthcare. INTERNATIONAL JOURNAL OF DISTRIBUTED SYSTEMS AND TECHNOLOGIES 2019. [DOI: 10.4018/ijdst.2019100104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Sensors and mobile phones shine in the Big Data area due to their capabilities to retrieve a huge amount of real-time data; which was not possible previously. In the specific field of healthcare, we can now collect data related to human behavior and lifestyle for better understanding. This pushed us to benefit from such technologies for early miscarriage prediction. This research study proposes to combine the use of Big Data analytics and data mining models applied to smartphones real-time generated data. A K-means data mining algorithm is used for clustering the dataset and results are transmitted to pregnant woman to make quick decisions; with the intervention of her doctor; through an android mobile application that we created. As well, she receives recommendations based on her behavior. We used real-world data to validate the system and assess its performance and effectiveness. Experiments were made using the Big Data Platform Databricks.
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Affiliation(s)
- Hiba Asri
- OSER Laboratory, Faculty of Sciences and Technologies, Cadi Ayyad University, Marrakesh, Morocco
| | - Hajar Mousannif
- LISI Laboratory, Faculty of Siences Semlalia, Cadi Ayyad University, Marrakesh, Morocco
| | - Hassan Al Moatassime
- OSER Laboratory, Faculty of Sciences and Technologies, Cadi Ayyad University, Marrakesh, Morocco
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15
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Hasani S, Mirghafourvand M, Esmaeilpour K, Sehhatie Shafaie F. The effect of counseling based on health promotion awareness on mental health and self-esteem in women with ectopic pregnancy: a randomized controlled clinical trial. J Matern Fetal Neonatal Med 2019; 34:1687-1694. [PMID: 31303080 DOI: 10.1080/14767058.2019.1644314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES In all types of pregnancies women experienced changes in their mental health and self-esteem condition. The aim of this study was to determine the effect of counseling on mental health and self-esteem following an ectopic pregnancy (EP). STUDY DESIGN This was a randomized controlled clinical trial on 68 pregnant women with EP referring to Al-Zahra hospital in Tabriz, Iran in 2018. The participants randomly allocated to counseling and control groups. Intervention group received four sessions of counseling including 1) providing medical information about EP and its physical and psychological complications; 2) explaining the syndrome of sadness after losing a pregnancy; 3) mental health and ways to improve it after pregnancy loss; and 4) self-esteem and how to increase it after losing a pregnancy and control group received only routine care. Before and 2 weeks after the end of the intervention, data were collected by the General Health Questionnaire-28 and Rosenberg self-esteem questionnaires. Data were analyzed using SPSS software. The registration number was IRCT20100109003027N41. RESULTS There was no significant difference between the two groups in terms of sociodemographic characteristics and the scores of mental health and self-esteem before the intervention. Two weeks after the end of the intervention, the mean (SD) total score of mental health of women in counseling and control groups were 20.1 (5.0) and 32.9 (9.8), respectively. When compared with the control group, a significant reduction in the total score of mental health (adjusted difference = -11.27; 95% confidence interval: -15.19 to -7.34; p < .001) was observed in the counseling group. In counseling group compared with the control group, a significant increase in the total score of self-esteem (adjusted difference = 4.79; 95% confidence interval: 3.07-6.51; p < .001) was observed. CONCLUSIONS Providing counseling based on health promotion awareness by the midwife can help reduce mental health problems and increase self-esteem. For this reason, counseling should be considered as part of care after losing a pregnancy.
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Affiliation(s)
- Sonia Hasani
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Iran
| | - Mojgan Mirghafourvand
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Iran
| | | | - Fahimeh Sehhatie Shafaie
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Iran
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16
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Farren J, Mitchell-Jones N, Verbakel JY, Timmerman D, Jalmbrant M, Bourne T. The psychological impact of early pregnancy loss. Hum Reprod Update 2019; 24:731-749. [PMID: 30204882 DOI: 10.1093/humupd/dmy025] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 07/31/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Early pregnancy loss (EPL) is a common event, with scope for long-term personal and societal impact. There are three decades worth of published evidence of profound psychological sequelae in a significant proportion of women. However, the wide variety of outcomes, screening instruments, assessment timings and geographical locations makes it challenging to form a coherent picture of the morbidity within the whole group and its subgroups. OBJECTIVE AND RATIONALE This review aims to investigate three questions. (1) What is the evidence for depression, anxiety and post-traumatic stress disorder (PTSD) following a miscarriage or an ectopic pregnancy in women and/or their partners? (2) What is the intensity and duration of these conditions, and how do they compare to those without losses? (3) Which patients have been found to be at highest risk of psychopathology? Answers to these questions are salient not only in day-to-day clinical interactions with those experiencing EPL, whose psychological needs may not be prioritized, but should also form the basis for tailoring healthcare policy in terms of screening for and treating the associated psychological morbidity. SEARCH METHODS The following databases were searched, from the start of each database up to July 2017: MEDLINE (Ovid interface, 1948 onwards), Embase classic + Embase (Ovid interface, 1947 onwards), and PsychINFO (Ovid interface, 1806 onwards). Search strategies were developed using medical subject headings (MeSH). The concepts of psychological morbidity (anxiety, depression or PTSD) and pregnancy loss (miscarriage or ectopic pregnancy) were first expanded with the Boolean operator 'or', then linked together using 'and'. Included studies were of prospective cohort design, including women or men following EPL (with the majority to have experienced losses before 24 weeks gestation), and reporting standardized psychometric measures for anxiety, depression and post-traumatic stress disorder. The timing of follow-up had to be specified and standardized across participants. Manuscript quality and risk of bias was assessed using the Newcastle-Ottawa Scale. OUTCOMES We found evidence of significant depression and anxiety in the first month following EPL in women. Partners were also shown to display depression and anxiety, albeit to a generally lower level. There is also evidence of post-traumatic stress symptoms relating to the EPL in three studies. WIDER IMPLICATIONS In view of their high frequency, EPLs can significantly contribute to the overall burden of psychopathology within a population. Recognition of this impact is important, so that severely affected individuals may be screened and treated appropriately. Further research to establish risk factors to promptly identify and treat these patients, and to optimize their management, is crucial.
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Affiliation(s)
- Jessica Farren
- Tommy's National Centre for Miscarriage Research, Queen Charlottes and Chelsea Hospital, Imperial College, London, UK.,Department of Obstetrics and Gynaecology, Imperial College Healthcare Trust, London, UK
| | - Nicola Mitchell-Jones
- Tommy's National Centre for Miscarriage Research, Queen Charlottes and Chelsea Hospital, Imperial College, London, UK.,Department of Obstetrics and Gynaecology, Chelsea and Westminster NHS Trust, London, UK
| | - Jan Y Verbakel
- KU Leuven, ACHG, Department of Public Health and Primary Care, Kapucijnenvoer 33, Leuven, Belgium.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, UK
| | - Dirk Timmerman
- KU Leuven, Department of Obstetrics and Gynaecology, Herestraat, Leuven, Belgium
| | - Maria Jalmbrant
- Tommy's National Centre for Miscarriage Research, Queen Charlottes and Chelsea Hospital, Imperial College, London, UK
| | - Tom Bourne
- Tommy's National Centre for Miscarriage Research, Queen Charlottes and Chelsea Hospital, Imperial College, London, UK.,Department of Obstetrics and Gynaecology, Imperial College Healthcare Trust, London, UK.,KU Leuven, Department of Obstetrics and Gynaecology, Herestraat, Leuven, Belgium
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17
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Obst KL, Due C. Australian men's experiences of support following pregnancy loss: A qualitative study. Midwifery 2019; 70:1-6. [DOI: 10.1016/j.midw.2018.11.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022]
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18
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Riggs DW, Due C, Tape N. Australian Heterosexual Men's Experiences of Pregnancy Loss: The Relationships Between Grief, Psychological Distress, Stigma, Help-Seeking, and Support. OMEGA-JOURNAL OF DEATH AND DYING 2018; 82:409-423. [PMID: 30558482 DOI: 10.1177/0030222818819339] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study explores experiences of pregnancy loss via a questionnaire completed by a convenience sample of 48 Australian cisgender heterosexual men. The questionnaire included measures of support following pregnancy loss, recognition of loss, perceived utility of help-seeking, perceived stigma attached to help-seeking, perinatal grief, and depression and anxiety. The questionnaire also included open-ended questions focused on help-seeking and support. Higher levels of grief were related to higher levels of both depression and anxiety. Perceptions about stigma were related to the perceived utility of help-seeking. While a majority of participants had accessed formal support services, feeling supported was unrelated to either grief or depression. Participants emphasized the utility of men's groups where members have experienced pregnancy loss, though barriers to support were also identified in terms of the unavailability of support or the perceived need to focus on a partner's loss.
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Affiliation(s)
- Damien W Riggs
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Clemence Due
- School of Psychology, The University of Adelaide, South Australia, Australia
| | - Nicole Tape
- School of Psychology, The University of Adelaide, South Australia, Australia
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19
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Bringing together the ‘Threads of Care’ in possible miscarriage for women, their partners and nurses in non-metropolitan EDs. Collegian 2018. [DOI: 10.1016/j.colegn.2017.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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20
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Volgsten H, Jansson C, Svanberg AS, Darj E, Stavreus-Evers A. Longitudinal study of emotional experiences, grief and depressive symptoms in women and men after miscarriage. Midwifery 2018; 64:23-28. [PMID: 29864578 DOI: 10.1016/j.midw.2018.05.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 04/10/2018] [Accepted: 05/07/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Although miscarriage is common and affects up to 20% of pregnant women, little is known about these couples' short term and long term experiences after miscarriage. The aim of the present study was to study emotional experience, grief and depressive symptoms in women and men, one week and four months after miscarriage. RESEARCH DESIGN /SETTING Women, (n = 103), and their male partner (n = 78), were recruited at the gynecological clinic after miscarriage. Control women were recruited from the general population. Three validated questionnaires concerning psychological wellbeing and mental health, RIMS, PGS and MADRS-S were answered by the participants one week and four months after the miscarriage. FINDINGS It was shown that for women, the emotional experiences of miscarriage, grief and depressive symptoms were more pronounced than for their male partners. Grief and depressive symptoms were reduced with time, which was not the case for the emotional experiences of miscarriage. Previous children was favorable for emotional experience while previous miscarriage or infertility treatment made the emotional experience worse. CONCLUSION Grief and depressive symptoms is reduced over time while emotional experiences such as isolation, loss of baby and a devastating event persist for longer time than four months. Lack of previous children, previous miscarriage and infertility diagnosis could increase negative emotional experiences after miscarriage, this was especially pronounced for grief reaction. The questionnaires could be used both clinically and in research to understand the emotional experiences after miscarriage.
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Affiliation(s)
- Helena Volgsten
- Department of Women's and Children's Health, Uppsala University, 751 85 Uppsala, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Caroline Jansson
- Department of Women's and Children's Health, Uppsala University, 751 85 Uppsala, Sweden
| | - Agneta Skoog Svanberg
- Department of Women's and Children's Health, Uppsala University, 751 85 Uppsala, Sweden
| | - Elisabeth Darj
- Department of Women's and Children's Health, Uppsala University, 751 85 Uppsala, Sweden; Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Department of Obstetrics and Gynecology, St Olav's Hospital, Trondheim, Norway
| | - Anneli Stavreus-Evers
- Department of Women's and Children's Health, Uppsala University, 751 85 Uppsala, Sweden.
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Jansson C, Volgsten H, Huffman C, Skoog Svanberg A, Swanson KM, Stavreus-Evers A. Validation of the Revised Impact of Miscarriage Scale for Swedish conditions and comparison between Swedish and American couples’ experiences after miscarriage. EUR J CONTRACEP REPR 2017; 22:412-417. [DOI: 10.1080/13625187.2017.1409346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Caroline Jansson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Helena Volgsten
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Carolyn Huffman
- College of Health Sciences, Appalachian State University USA
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22
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Due C, Chiarolli S, Riggs DW. The impact of pregnancy loss on men's health and wellbeing: a systematic review. BMC Pregnancy Childbirth 2017; 17:380. [PMID: 29141591 PMCID: PMC5688642 DOI: 10.1186/s12884-017-1560-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/03/2017] [Indexed: 12/03/2022] Open
Abstract
Background Research indicates that men’s psychological and physical health outcomes after pregnancy loss differ from those of women. Our goal was to identify all literature with a focus on men’s experiences of pregnancy loss in order to outline current evidence concerning men’s wellbeing. Methods A systematic review of literature on men and pregnancy loss was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), Joanna Briggs Institute (JBI) and Social Care Institute for Excellence (SCIE) guidelines. Literature was sourced from PsycINFO, PubMed, Scopus, CINAHL, and Google Scholar. Inclusion criteria were 1) studies that focused on pregnancy loss (including miscarriage, stillbirth, and ectopic pregnancy, 2) that men’s voices were specifically represented, and 3) that studies were of primary data. Results A final sample of 29 articles was identified, of which 16 were quantitative, 10 qualitative, and 3 mixed methods. Quantitative and mixed methods studies indicated that while men tended to have less intense and less enduring levels of negative psychological outcomes than women, they are more likely to engage in compensatory behaviours, such as increased alcohol consumption. Qualitative studies indicated that men often feel that their role is primarily as a ‘supporter’ to their female partner, and that this precludes recognition of their own loss. These studies also reported that men may feel overlooked and marginalised in comparison to their female partners, whose pain is typically more visible. Conclusions Further research is needed on men’s experiences of pregnancy loss, focusing on cultural differences. The experience of gay and/or transgender men who face pregnancy loss is overlooked in the literature to date.
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Affiliation(s)
- Clemence Due
- School of Psychology, The University of Adelaide, Adelaide, South Australia, 5005, Australia.
| | - Stephanie Chiarolli
- School of Psychology, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Damien W Riggs
- School of Social and Policy Studies, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia
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23
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Cullen S, Coughlan B, Casey B, Power S, Brosnan M. Exploring parents' experiences of care in an Irish hospital following second-trimester miscarriage. ACTA ACUST UNITED AC 2017. [DOI: 10.12968/bjom.2017.25.2.110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sarah Cullen
- Bereavement liaison midwife, National Maternity Hospital, Dublin, Ireland
| | - Barbara Coughlan
- Lecturer/assistant professor, University College Dublin, Ireland
| | - Brenda Casey
- Bereavement liaison midwife, National Maternity Hospital, Dublin, Ireland
| | | | - Mary Brosnan
- Director of Nursing and Midwifery, National Maternity Hospital, Dublin, Ireland
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24
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25
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26
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Disrupted Transition to Parenthood: Gender Moderates the Association Between Miscarriage and Uncertainty About Conception. SEX ROLES 2015. [DOI: 10.1007/s11199-015-0564-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Couples and Miscarriage: The Influence of Gender and Reproductive Factors on the Impact of Miscarriage. Womens Health Issues 2015; 25:570-8. [DOI: 10.1016/j.whi.2015.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 04/06/2015] [Accepted: 04/10/2015] [Indexed: 12/13/2022]
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28
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Randolph AL, Hruby BT, Sharif S. Counseling Women Who Have Experienced Pregnancy Loss: A Review of the Literature. ADULTSPAN JOURNAL 2015. [DOI: 10.1002/j.2161-0029.2015.00032.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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29
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McCarthy FP, Moss-Morris R, Khashan AS, North RA, Baker PN, Dekker G, Poston L, McCowan L, Walker JJ, Kenny LC, O'Donoghue K. Previous pregnancy loss has an adverse impact on distress and behaviour in subsequent pregnancy. BJOG 2015; 122:1757-64. [PMID: 25565431 DOI: 10.1111/1471-0528.13233] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate whether women with previous miscarriages or terminations have higher levels of anxiety, depression, stress, and altered behaviours in a subsequent pregnancy. DESIGN A retrospective analysis of 5575 women recruited into the Screening for Pregnancy Endpoints (SCOPE) study, a prospective cohort study. SETTING Auckland, New Zealand, Adelaide, Australia, Cork, Ireland, and Manchester, Leeds, and London, UK. POPULATION Healthy nulliparous women with singleton pregnancies. METHODS Outcomes were recorded at 15 and 20 weeks of gestation. MAIN OUTCOME MEASURES Short-form State-Trait Anxiety Inventory (STAI) score, Perceived Stress Scale score, Edinburgh Postnatal Depression Scale score, and pregnancy-related behaviour measured using behavioural responses to pregnancy score. RESULTS Of the 5465 women included in the final analysis, 559 (10%) had one and 94 (2%) had two previous miscarriages, and 415 (8%) had one and 66 (1%) had two previous terminations of pregnancy. Women with one previous miscarriage had increased anxiety (adjusted mean difference 1.85; 95% confidence interval, 95% CI 0.61-3.09), perceived stress (adjusted mean difference 0.76; 95% CI 0.48-1.03), depression (adjusted odds ratio, aOR 1.26; 95% CI 1.08-1.45), and limiting/resting behaviour in pregnancy (adjusted mean difference 0.80; 95% CI 0.62-0.97). In women with two miscarriages, depression was more common (aOR 1.65; 95% CI 1.01-2.70) and they had higher scores for limiting/resting behaviour in pregnancy (adjusted mean difference 1.70; 95% CI 0.90-2.53) at 15 weeks of gestation. Women with one previous termination displayed elevated perceived stress (adjusted mean difference 0.65; 95% CI 0.08-1.23) and depression (aOR 1.25; 95% 1.08-1.45) at 15 weeks of gestation. Women with two previous terminations displayed increased perceived stress (adjusted mean difference 1.43; 95% CI 0.00-2.87) and depression (aOR 1.67; 95% 1.28-2.18). CONCLUSIONS This study highlights the psychological implications of miscarriage and termination of pregnancy.
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Affiliation(s)
- F P McCarthy
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland.,Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK
| | - R Moss-Morris
- King's College London, Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - A S Khashan
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - R A North
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK
| | - P N Baker
- Liggins Institute, University of Auckland, Auckland, New Zealand.,University of Manchester, Department of Obstetrics and Gynaecology, Manchester, UK
| | - G Dekker
- Women's and Children's Division, Lyell McEwin Hospital, University of Adelaide, Adelaide, Australia
| | - L Poston
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK
| | - Lme McCowan
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - J J Walker
- St James University Hospital, Leeds, UK, on behalf of the SCOPE consortium
| | - L C Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - K O'Donoghue
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
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30
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Kong GWS, Chung TKH, Lok IH. The impact of supportive counselling on women's psychological wellbeing after miscarriage - a randomised controlled trial. BJOG 2014; 121:1253-62. [PMID: 24912398 DOI: 10.1111/1471-0528.12908] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2014] [Indexed: 11/29/2022]
Affiliation(s)
- GWS Kong
- Department of Obstetrics and Gynaecology; The Chinese University of Hong Kong; Prince of Wales Hospital; Hong Kong China
| | - TKH Chung
- Department of Obstetrics and Gynaecology; The Chinese University of Hong Kong; Prince of Wales Hospital; Hong Kong China
| | - IH Lok
- Department of Obstetrics and Gynaecology; The Chinese University of Hong Kong; Prince of Wales Hospital; Hong Kong China
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31
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Feodor Nilsson S, Andersen PK, Strandberg-Larsen K, Nybo Andersen AM. Risk factors for miscarriage from a prevention perspective: a nationwide follow-up study. BJOG 2014; 121:1375-84. [DOI: 10.1111/1471-0528.12694] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2013] [Indexed: 11/29/2022]
Affiliation(s)
- S Feodor Nilsson
- Section of Social Medicine; Department of Public Health; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - PK Andersen
- Section of Biostatistics; Department of Public Health; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - K Strandberg-Larsen
- Section of Social Medicine; Department of Public Health; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - A-M Nybo Andersen
- Section of Social Medicine; Department of Public Health; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
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32
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Robinson GE. Pregnancy loss. Best Pract Res Clin Obstet Gynaecol 2013; 28:169-78. [PMID: 24047642 DOI: 10.1016/j.bpobgyn.2013.08.012] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 06/25/2013] [Accepted: 08/22/2013] [Indexed: 01/19/2023]
Abstract
Women who lose desired pregnancies by miscarriage, stillbirth, or genetic termination are at risk of suffering from grief, anxiety, guilt and self-blame that may even present in subsequent pregnancies. It is important to find effective means of helping women deal with these losses. The approach to stillbirth has shifted from immediately removing the child from the mother to encouraging the parents to view and hold the baby. This approach has been questioned as possibly causing persistent anxiety and post-traumatic stress disorder. Women who miscarry are currently encouraged to find ways to memorialise the lost fetus. Couples who decide to terminate a pregnancy after discovering a defect may deal not only with sadness but also guilt. Immediate crisis intervention and follow-up care should be available, recognising that individual women may experience different reactions and their specific post-loss needs must be assessed.
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Affiliation(s)
- Gail Erlick Robinson
- University of Toronto, University Health Network, Toronto General Hospital, Eaton Wing North, 8th Floor, Room 231, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
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Abstract
Vaginal bleeding, abdominopelvic pain, nausea, and vomiting are common presenting symptoms in early pregnancy. All women of reproductive age who present with abdominal or pelvic pain or with vaginal bleeding should be evaluated for possible pregnancy. There should be a high index of suspicion for ectopic pregnancy in women presenting with abdominal pain and bleeding after approximately 7 weeks of amenorrhea. Investigation for the cause of the bleeding should ensue. Gestational trophoblastic disease should be considered as a possible cause. Treatment options for nausea during pregnancy should be discussed with women with this common symptom.
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Affiliation(s)
- A Ildiko Martonffy
- Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Court, Madison, WI 53715, USA.
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34
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Abstract
Women who lose desired pregnancies by miscarriage, stillbirth, genetic termination, or unsuccessful in vitro fertilization are at risk of suffering from grief, anxiety, guilt, and self-blame that may even present in subsequent pregnancies. A review of the literature reveals the dilemmas about effective means of helping women deal with these losses. The approach to stillbirth has shifted from immediately removing the child from the mother to encouraging viewing and holding the baby. This approach has been questioned as possibly causing persistent anxiety. Women who miscarry are currently encouraged to find ways to memorialize the lost fetus. Immediate crisis intervention and follow-up care should be available, recognizing that individual women may experience different reactions and their specific postloss needs must be assessed.
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