Timing of Physical and Emotional Intimate Partner Violence Exposure and Women's Health in an Australian Longitudinal Cohort Study

Drawing on data from a prospective pregnancy cohort (N = 1,507), this study examines the relationship between exposure to physical and emotional intimate partner violence (IPV) across the first 10 years of motherhood and women's mental and physical health. A measure of IPV (Composite Abuse Scale) was included at 1, 4, and 10 years postpartum. Past year and prior experiences of IPV were associated with mental and physical health issues at 10 years, both for mothers who had experienced combined IPV and emotional IPV alone. Awareness of the health issues associated with different types of IPV can assist in tailoring responses for women who experience IPV.

Developing and testing an integrated patient mHealth and provider dashboard application system for type 2 diabetes management among Medicaid-enrolled pregnant individuals based on a user-centered approach: Mixed-methods study

Background

A tailored and integrated technology solution (patient mHealth application and provider dashboard) can provide a 360° view of Medicaid-enrolled patients with type 2 diabetes (T2D) during pregnancy that could improve health outcomes and address health inequities.

Objectives

To develop a set of user specifications for the mHealth and dashboard applications, develop prototypes based on user needs, and collect initial impressions of the prototypes to subsequently develop refined tools that are ready for deployment.

Methods

Study activities followed a double-diamond framework with a participatory design mindset. Activities were divided into two phases focused on a qualitative inquiry about participant needs and values (phase 1) and design, development, and usability testing of low and high-fidelity prototypes (phase 2).

Results

We identified themes that exemplified pregnancy experience among Medicaid-enrolled individuals with T2D. Patients (n  =  7) and providers (n  =  7) expressed a core set of expectations for the mHealth and dashboard applications. Participants provided feedback to improve the mHealth and dashboard. For both applications, participants reported scores for the NASA Task load Survey (TLX) that were in the 20th percentile of national TLX scores.

Conclusions

Digital health tools have the ability to transform health care among Medicaid-enrolled patients with T2D during pregnancy, with the goal of managing their blood glucose levels, which is a precursor to experiencing a successful pregnancy and birth. Distilling patient and provider needs and preferences-then using them, along with prior studies and theory, to develop applications-holds great potential in tackling complicated health care issues.

Living with the Threat of Covid-19: Exploring the Psychological Impact of Covid-19 in Those who Conceived Through ART Versus Spontaneously

OBJECTIVES

To explore and compare anxiety relating to the threat of Covid-19 in pregnancy by women who conceived through assisted reproductive technology (ART) and spontaneously. We also examined the psychological coping strategies used and lived experience for both groups.

METHODS

A total of 21 women who conceived through ART at a private university based IVF and a matched sample of women who conceived spontaneously were enrolled from July 2020 to February 2021. This was a mixed methods study. Covid-19-specific anxiety was measured using the coronavirus anxiety scale (CAS) as well as a validating qualitative data model with the use of open-ended questions to expand on quantitative findings.

RESULTS

In both groups of women the level of anxiety detected by the CAS was low and mixed coping strategies (emotion-focused and problem-solving) were utilized. The ART group expressed more positive feelings towards pregnancy during the Covid-19 pandemic.

CONCLUSION

The vulnerable ART group is no more at risk for negative emotional well-being during the Covid-19 pandemic. Additionally, healthcare providers ought to be knowledgeable of various Covid-19 coping strategies that may provide emotionally protective measures for all women of reproductive age. This is of particular importance as effective coping may ultimately prevent disruptions that could compromise prenatal care during the covid-19 pandemic.

High levels of depressive symptoms and low quality of life are reported during pregnancy in Cape Coast, Ghana; a longitudinal study

Background

Significant rates of anxiety, depressive symptoms, and low quality of life (QoL) have been found among pregnant women in developed countries. These psychosocial disturbances have not been adequately assessed during pregnancy in many developing countries.

Methods

Women were recruited in their first trimester of pregnancy (< 13 weeks; n = 116) and followed through to their 2^nd (n = 71) and 3^rd (n = 71) trimesters. Questionnaires were used to collect data on anxiety symptoms (Beck Anxiety Inventory; BAI), depressive symptoms (Center for Epidemiological Studies-Depression Inventory; CES-D), and quality of life (RAND SF-36; QoL). Psychometric analyses were used to determine the reliability of the questionnaires in this context. The proportion of pregnant women with psychosocial disturbances at each trimester was determined. Repeated measures ANOVA were used to examine changes in psychosocial outcomes over time; and generalized estimating equation to determine if gestational age predicted the psychosocial outcomes whilst controlling for sociodemographic variables.

Results

Participants were aged 27.1 ± 5.2 years, on average. Psychometric analyses revealed a 4-factor solution for BAI (18 items), 1-factor solution for CES-D (13 items) and 4-factor solution for RAND SF-36 (26 items). The prevalence estimate of psychosocial disturbances was 34%, 10%, 2% (anxiety), 49%, 31%, 34% (depressive symptoms), and 46%, 37%, 59% (low QoL) for 1^st, 2^nd and 3^rd trimesters, respectively. Gestational age and food insecurity were significant predictors of depressive symptoms, anxiety symptoms and QoL.

Conclusions

In this population of Ghanaian women, the levels of depressive symptoms and low QoL observed across pregnancy should be recognized as major public health problems and efforts to address these should be put in place. Addressing food insecurity may be a major step to solve not only the physical needs of the pregnant woman but also the psychological needs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13299-2.

Physical and Emotional Intimate Partner Violence and Women's Health in the First Year After Childbirth: An Australian Pregnancy Cohort Study

Intimate partner violence (IPV) can comprise physical, sexual, and emotional abuse, and is a widespread public health concern. Despite increasing recognition that women experience different types of IPV, the majority of research has focused on physical IPV. The present study aims to examine associations between different types of IPV (physical, emotional, physical, and emotional) and women's mental, physical, and sexual health by analyzing longitudinal data from a prospective pregnancy cohort of 1,507 first-time mothers in Melbourne, Australia. Questionnaires included validated measures of physical and mental health (Short Form Health Survey, Edinburgh Postnatal Depression Scale) and IPV (Composite Abuse Scale). Emotional IPV alone was the most commonly reported type of IPV (n = 128, 9.5%), followed by both physical and emotional IPV (n = 76, 5.7%), and then physical IPV alone (n = 30, 2.2%). Women reporting emotional IPV or physical and emotional IPV had increased odds of poor health compared with women reporting no IPV. Experience of physical and emotional IPV was most strongly associated with mental health issues, including depressive symptoms (adjusted odds ratio [OR] 4.6, 95% confidence interval [CI] = [2.9, 7.1]) and self-reported anxiety (adjusted OR 2.9, 95% CI = [1.9, 4.4]). Experience of emotional IPV alone was associated with poor mental health as well as physical factors, including poor general physical health (adjusted OR 1.9, 95% CI = [1.2, 3.1]), and pain during sex (adjusted OR 1.8, 95% CI = [1.2, 2.7]). Increased odds of poor body image were also observed for women reporting emotional IPV alone and physical and emotional IPV. These findings highlight the need for greater awareness of the diversity in women's experiences of IPV among health care providers. This includes understanding the prevalence of emotional IPV among new mothers, and the range of health problems that are more common for women experiencing IPV.

Patterns of maternal depression, anxiety, and stress symptoms from pregnancy to 5 years postpartum in an Australian cohort experiencing adversity

The objective of this study is to describe the longitudinal patterns of depression, anxiety, and stress symptoms from pregnancy to 5 years postpartum, in a cohort of Australian mothers experiencing adversity. Longitudinal data were drawn from the control group of a trial of nurse home visiting. Pregnant women experiencing adversity (≥ 2 of 10 adversity risk factors) were recruited from antenatal clinics across 2 Australian states (30 April 2013-29 August 2014). Women completed the Depression Anxiety and Stress Scales short-form (DASS-21) at 11 time-points from pregnancy to 5 years postpartum. DASS-21 scores were summarized at each time-point for all women and by level of adversity risk. Three hundred fifty-nine women (100%) completed the DASS-21 in pregnancy and 343 (96%) provided subsequent data. Mental health symptoms were highest in pregnancy and at 4 and 5 years postpartum. While this pattern was comparable across levels of antenatal adversity risk, women with greatest adversity risk had consistently higher mental health symptoms. In a cohort of mothers experiencing adversity, depression, anxiety, and stress symptoms were highest in pregnancy and at 4 to 5 years postpartum. The striking patterns of persistent, high, mental health symptoms, beyond the first year postpartum, can inform a more equitable and responsive health system.

The maternal health study: Study design update for a prospective cohort of first-time mothers and their firstborn children from birth to age ten

BACKGROUND

Maternal health is critical to the health and well-being of children and families, but is rarely the primary focus of pregnancy and birth cohort studies. Globally, poor maternal health and the exposure of women and children to family violence contribute to the perpetuation and persistence of intergenerational health inequalities.

OBJECTIVES

The Maternal Health Study was designed to investigate the contribution of social and obstetric risk factors to common maternal physical and psychological morbidities. Over time, our focus has expanded to include mother-child pairs and investigation of intergenerational trauma and family violence.

POPULATION

A total of 1507 first-time mothers were recruited in early pregnancy from six public hospitals in Melbourne, Australia, in 2003-2005.

METHODS

Women completed questionnaires or telephone interviews in early pregnancy (≤24 weeks); at 32 weeks' gestation; at three, six, nine, 12 and 18 months postpartum; and at four and ten years. At ten years, women and children were invited to participate in face-to-face interviews, which included direct assessment of children's cognitive and language development. A wide range of obstetric, social and contextual factors have been measured, including exposure to intimate partner violence (IPV) (1-year, 4-year and 10-year follow-up).

RESULTS

1507 eligible women were recruited at a mean gestation of 15 weeks. At one year, four years and ten years postpartum, 90.0%, 73.1% and 63.2% of the original cohort took part in follow-up. One in three women in the study (34.5%) reported exposure to IPV in the first ten years of motherhood: 19% in the first 12 months postpartum, 20% in the year prior to four-year follow-up and 18.3% in the year prior to ten-year follow-up.

CONCLUSION

The study affords a unique opportunity to examine patterns of maternal and child health and health service use associated with exposure to IPV.

The associations of pregnancy-related symptoms with health-related quality of life at midpregnancy: the PregnActive project

AIM

To analyze the associations between the wide range of pregnancy-related symptoms and health-related quality of life.

MATERIAL AND METHODS

A cross-sectional study was developed among 155 healthy low-risk pregnant women, aged 18-45 years, participated in the study at midpregnancy. Health-related quality of life and pregnancy symptoms were assessed using the Medical Outcome Study 36-item short form questionnaire and the Pregnancy Symptoms Inventory, respectively. Simple correlations, hierarchical linear regressions and standard multiple regressions were performed.

RESULTS

Significant correlations, after adjusting for sociodemographic and anthropometric characteristics, were found between five pregnancy-related symptoms and physical component of health-related quality of life and between thirteen pregnancy-related symptoms and mental component. However, when all pregnancy symptoms were entered simultaneously into a multiple regression model, back pain and shortness of breath on the physical components, and feeling depressed and anxiety on the mental component were the main explanatory factors of health-related quality of life.

CONCLUSION

Among the wide range of pregnancy-related symptoms, back pain, hip or pelvic pain, shortness of breath, and feeling depressed and anxiety are the main symptoms affecting the physical and the mental components of health-related quality of life, respectively. An early detection of the pregnancy-related symptoms that may affect health-related quality of life enables early interventions aimed at ameliorating their negative impact on health-related quality of life and daily living activities at midpregnancy.

New persistent opioid use after acute opioid prescribing in pregnancy: a nationwide analysis

OBJECTIVE

To evaluate the association between opioid prescribing during pregnancy and new persistent opioid use in the year following delivery.

MATERIALS AND METHODS

This nationwide retrospective cohort study included patients aged 12-55 years in Optum's deidentified Clinformatics Data Mart Database who were undergoing vaginal delivery or cesarean delivery from 2008 to 2016, with continuous enrollment from 2 years before birth to 1 year postdischarge. Women were included if they were opioid naive in pregnancy (ie, did not fill an opioid prescription 2 years to 9 months before delivery) and did not undergo a procedure within the year after discharge. The exposure was filling an opioid prescription in pregnancy. The primary outcome was new persistent opioid use, defined as a pharmacy claim for ≥1 opioid prescription between 4 and 90 days postdischarge and ≥1 prescription between 91 and 365 days postdischarge. Clinical and demographic covariates were included. Analyses included descriptive statistics and multivariable logistic regression, adjusting for clinical and demographic covariates.

RESULTS

Of 158,425 childbirths identified, 101,013 (63.8%) were by vaginal delivery and 57,412 (36.2%) cesarean delivery. Among all patients, 6.0% (9429) filled an opioid prescription during pregnancy. The factors associated with filling an opioid in pregnancy were having a nondelivery procedure in pregnancy (adjusted odds ratio, 9.60; 95% confidence interval, 8.81-10.47) and having an emergency room visit during pregnancy (adjusted odds ratio, 2.48; 95% confidence interval, 2.37-2.59). Of women who received an opioid in pregnancy, 4% (379) developed new persistent opioid use. The factors most associated with new persistent opioid use were receiving an opioid prescription during pregnancy (adjusted odds ratio, 3.45; 95% confidence interval, 3.04-3.92) and filling a peripartum opioid prescription (1 week prior to 3 days postdischarge) adjusted odds ratio, 2.28, 95% confidence interval (2.02-2.57). Though having a procedure during pregnancy was associated with increased receipt of an opioid prescription, it was also associated with reduced new persistent opioid use (adjusted odds ratio, 0.72; 95% confidence interval, 0.52-0.99).

CONCLUSION

Women who receive an opioid prescription during pregnancy are more likely to experience new persistent opioid use. Maternity care providers must balance pain management in pregnancy with potential risks of opioids.

Examining to what extent pregnancy-related physical symptoms worry women in the first trimester of pregnancy: a cross-sectional study in general practice

BACKGROUND

Women often wish to discuss their pregnancy symptoms with their GP. However, the two parties' understanding of symptoms may not be aligned.

AIM

To examine to what degree a specific pregnancy-related symptom worried women in the first trimester and analyse the characteristics of the most worried women.

DESIGN & SETTING

A cross-sectional study was performed in general practice in Denmark from 1 March 2015-15 August 2016.

METHOD

Women attending the first prenatal care visit completed a questionnaire about pregnancy-related physical symptoms and worries. Women were recruited from 125 GP practices and 294 GPs participated in the study. Further data were obtained from their pregnancy health record. Multivariable logistic regression analysis was used to assess the associations between the women's worries and the severity of the symptoms, which were adjusted for age and parity.

RESULTS

A total of 1508 women, aged 16-45 years, were included and 1455 completed the questionnaire. Nausea, vomiting, pelvic cavity pain, and back pain were the most common symptoms, and 88% reported having two or more symptoms simultaneously. Among the 1278 women reporting nausea, only 21% were worried, while 88% of the 252 women reporting vaginal bleeding were worried. Primigravidae (those pregnant for the first time) were significantly more worried about vomiting and nausea than multigravidae (those who have experienced pregnancy previously). Those aged >35 years were more worried about pelvic girdle pain and pelvic cavity pain than younger women.

CONCLUSION

Pregnancy-related physical symptoms are frequent in the first trimester. The severity of worries depends on the symptom. Vaginal bleeding and pain give rise to the majority of severe worries, especially among young women.

Intergenerational Impacts of Family Violence - Mothers and Children in a Large Prospective Pregnancy Cohort Study

BACKGROUND

Violence and other adversities commonly co-occur, yet are usually investigated individually. The primary objectives of this paper are to investigate: (i) the relationship between maternal exposure to violence (including childhood abuse and intimate partner violence) and postpartum mental and physical health; and (ii) the extent to which exposure to violence and poor maternal mental and physical health are associated with children's emotional-behavioral difficulties.

METHODS

Prospective pregnancy cohort (n = 1507) followed up to 4 year postpartum. Validated measures used: Composite Abuse Scale; Edinburgh Postnatal Depression Scale, SF-36, Child Maltreatment History Self Report; Strengths and Difficulties Questionnaire. Logistic regression was used to investigate associations between maternal childhood abuse, intimate partner violence (IPV), maternal health and child emotional and behavioral difficulties at age 4.

OUTCOMES

Two out of five women (41%) reported abuse in childhood, and almost one in three (29%) reported IPV during the first four years of motherhood. Women reporting both physical and sexual childhood abuse had markedly raised odds of IPV and poor physical and mental health at all time points (pregnancy, first year postpartum and four year postpartum). For the index child, violence exposures (maternal childhood abuse or IPV) and poor maternal physical or mental health were associated with higher odds of emotional/behavioral difficulties at age four. In multivariable models (adjusted for child gender and maternal age), cumulative exposures (multiple violence exposures or poor maternal mental or physical health at multiple time points) each independently added to increased odds of emotional-behavioral difficulties. Children of mothers who reported a history of childhood abuse but were not exposed to IPV had odds of difficulties similar to children of mothers not reporting any violence exposure, suggesting resilient outcomes where violence experiences are not repeated in the next generation.

INTERPRETATION

The clustering of risk (child and adult violence experiences) and the accumulation of risk within families (IPV, poor maternal health, child difficulties) highlight the need for effective early intervention to limit or ameliorate the impact of violence across the lifespan, and to break the intergenerational cycle of disadvantage.

Psychotropic medication use and intimate partner violence at 4 years postpartum: Results from an Australian pregnancy cohort study

BACKGROUND

In the perinatal period, maternal mental health problems and intimate partner violence often co-occur. We aimed to examine associations between psychotropic medication use and intimate partner violence (IPV) in an Australian population-based sample.

METHODS

Prospective cohort study of 1507 first-time mothers recruited in early pregnancy (mean gestation 15 weeks) from public maternity hospitals in Melbourne Australia. Follow-up questionnaires at 12 months and four years included validated measures of intimate partner violence (Composite Abuse Scale), and maternal mental health (Edinburgh Postnatal Depression Scale, SF-36). Data on use of psychotropic medications was collected using a self-report measure at four years postpartum.

RESULTS

At four years postpartum, almost one in eight mothers (13.9%) were taking psychotropic medication. The prevalence of psychotropic medication use in women experiencing concurrent IPV was considerably higher compared to women not experiencing IPV (25% vs 11%, Odds Ratio = 2.68, 95% CI 1.73-4.15). Women experiencing IPV were significantly more likely to be taking psychotropic medication, even after adjusting for sociodemographic factors and depressive symptoms (Adj OR = 1.86, 95% CI 1.16 to 2.96). Only 5% of women reporting IPV at four years postpartum had discussed this with a general practitioner.

LIMITATIONS

Limitations include use of a self-report measure to assess psychotropic medication use, lack of data on the use of psychological counselling and/or other specialist mental health services and potential for attrition to bias results (addressed using multiple imputation).

CONCLUSIONS

Our findings reinforce the need for health professionals treating women for depressive symptoms to inquire about IPV and tailor responses accordingly.

Relations between Stress and Quality of Life among Women in Late Pregnancy: The Parallel Mediating Role of Depressive Symptoms and Sleep Quality

OBJECTIVE

This study aims to examine the parallel multiple mediators of depressive symptoms and sleep quality in the relations between stress and physical health-related quality of life (PHQOL)/mental health-related quality of life (MHQOL) among the women in late pregnancy.

METHODS

Of 1120 pregnant women participated in the cross-sectional study which consisted of Perceived Stress Scale, Edinburgh Postnatal Depression Scale, Pittsburgh Sleep Quality Index and MOS 12-item Short Form Health Survey. Parallel multiple mediator models were used to analyze the relations between stress, depressive symptoms, sleep quality and PHQOL/MHQOL.

RESULTS

The effect of perceived stress on PHQOL was partially through the indirect path of sleep quality (β=-0.061). But in the model for MHQOL, depressive symptoms and sleep quality played parallel mediators, and the indirect path effect of depressive symptoms (β=-0.179) was higher than sleep quality (β=-0.029).

CONCLUSION

The findings contributed to the understanding about the influential mechanism of stress on PHQOL/MHQOL. And it reminded the importance of sleep quality and depressive symptoms for improving QOL in late pregnancy.

Physical discomfort in early pregnancy and postpartum depressive symptoms

PURPOSE

Pregnancy examinations conducted in general practice focus mainly on identifying high-risk pregnancies and pregnancy complications. The pregnancy health record has a biomedical focus, and consequently the woman's mental well-being may receive less attention. The aim of this study was to evaluate the extent to which early pregnancy-related symptoms should be considered as indicators of an increased risk of postpartum depression.

MATERIALS AND METHODS

For a prospective cohort of 1508 pregnant women, the presence of 11 pregnancy-related symptoms was recorded at the first prenatal care consultation together with background information about socio-demography and health. Depression was assessed 8 weeks postpartum with the major depression inventory (MDI) and depression was considered present if MDI > 20. Multivariable logistic regression was used to assess the association between pregnancy-related symptoms and postpartum depressive symptoms, and to adjust for potential confounders.

RESULTS

A high depression score (MDI score >20) 8 weeks postpartum was found among 6.6% of the women and showed apparent associations with physical discomfort in early pregnancy, such as back pain and pelvic cavity pain. Analysis of confounding revealed, however, that signs of vulnerable mental health, present in early pregnancy, explained most of these associations.

CONCLUSIONS

Indicators of an increased risk of postpartum depressive symptoms may be found in early pregnancy. Pregnancy-related pain in the first trimester may be a sign of psychological vulnerability or an aspect of an existing depressive state that calls for attention.

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

AIMS

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

BACKGROUND

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

DESIGN

An exploratory cross-sectional design was used.

METHODS

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

RESULTS

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

CONCLUSIONS

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

Impact of gastroesophageal reflux disease symptoms on the quality of life in pregnant women: a prospective study

OBJECTIVE

Pregnant women often suffer from gastroesophageal reflux disease (GERD). GERD symptoms are known to influence the quality of life; however, there is a lack of data in pregnant women. The aim of this study was to establish the impact of GERD symptoms on health-related quality of life (HRQOL) during pregnancy.

PARTICIPANTS AND METHODS

A prospective longitudinal cohort study to investigate the impact of GERD symptoms on the HRQOL was carried out in 510 pregnant women and 330 nonpregnant women as controls. Two validated questionnaires, the Reflux Disease Questionnaire and the Quality of Life in Reflux and Dyspepsia Questionnaire, were used.

RESULTS

The study showed a significant negative impact on HRQOL in pregnant women with GERD symptoms. All five areas, emotional distress, sleep disturbance, vitality, food/drink problems, and physical/social functioning, were significantly reduced, but the most significant impact was on sleep (Quality of Life in Reflux and Dyspepsia Questionnaire score -35%). Overall, quality of life in women with GERD worsened throughout pregnancy.

CONCLUSION

GERD is frequently seen in pregnant women and has a negative impact on HRQOL, especially in late pregnancy. Therefore, there is a need for adequate therapy of GERD in pregnant women and HRQOL could be an adequate monitoring tool in this population.

Physical, sexual and social health factors associated with the trajectories of maternal depressive symptoms from pregnancy to 4 years postpartum

PURPOSE

Few studies have examined the course of maternal depressive across pregnancy and early parenthood. The aim of this study was to identify the physical, sexual and social health factors associated with the trajectories of maternal depressive symptoms from pregnancy to 4 years postpartum.

METHOD

Data were drawn from 1102 women participating in the Maternal Health Study, a prospective pregnancy cohort study in Melbourne, Australia. Self-administered questionnaires were completed at baseline (<24 weeks gestation), and at 3-, 6-, 12-, and 18 months, and 4 years postpartum.

RESULTS

Latent class analysis modelling identified three distinct classes representing women who experienced minimal depressive symptoms (58.4%), subclinical symptoms (32.7%), and persistently high symptoms from pregnancy to 4 years postpartum (9.0%). Risk factors for subclinical and persistently high depressive symptoms were having migrated from a non-English speaking country, not being in paid employment during pregnancy, history of childhood physical abuse, history of depressive symptoms, partner relationship problems during pregnancy, exhaustion at 3 months postpartum, three or more sexual health problems at 3 months postpartum, and fear of a partner since birth at 6 months postpartum.

CONCLUSIONS

This study highlights the complexity of the relationships between emotional, physical, sexual and social health, and underscores the need for health professionals to ask women about their physical and sexual health, and consider the impact on their mental health throughout pregnancy and the early postpartum.

[The arduous route of a 33-year-old woman with headache]

This article presents the case of a 33-year-old female patient with exacerbation of a pre-existing tension type headache. The exacerbation occurred within the scope of an infection and persisted after the infection had receded. The excessive diagnostic approaches went on for weeks and only finally came to an end with the diagnosis of a pregnancy. The impacts of hormonal changes on headaches caused by pregnancy are discussed as well as postinfection events.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Frequency of "Time for Self" Is a Significant Predictor of Postnatal Depressive Symptoms: Results from a Prospective Pregnancy Cohort Study

BACKGROUND

We aimed to explore the relationship between frequency of time for self and maternal depressive symptoms at 6 months postpartum.

METHODS

A prospective cohort study of 1,507 first-time mothers in Australia, recruited in early pregnancy with follow-up at 6 months postpartum, was conducted. Scores of more than or equal to 13 on the Edinburgh Postnatal Depression Scale were used to identify depressive symptoms.

RESULTS

Of 1,507 women recruited to the study, 92.6 percent completed follow-up at 6 months postpartum. Almost half (48.5%) reported having time for themselves when someone else looked after their baby (time for self) once a week or more. Compared with women who reported less frequent time for self, women who had time for themselves once a week or more were less likely to report depressive symptoms (unadjusted OR 0.44 [95% CI 0.30-0.66]). Women who had more frequent time for themselves were more likely to have more practical and emotional support. However, this only partially explained the relationship between time for self and depressive symptoms, which remained significant in regression models after adjusting for other recognized risk factors for maternal depression, including social support (adjusted OR 0.60 [95% CI 0.39-0.94]).

CONCLUSIONS

Our findings suggest that having time for self at least once a week in the first 6 months after childbirth may have a beneficial influence on maternal mental health. Ensuring women get regular respite from the challenges of caring for a young baby may be a relatively simple and effective way of promoting maternal mental health in the year after childbirth.

Maternal depression from pregnancy to 4 years postpartum and emotional/behavioural difficulties in children: results from a prospective pregnancy cohort study

Considerable attention has been focused on women's mental health in the perinatal period and the subsequent impacts on children. Comparatively, we know much less about maternal depression at later time points and the potential implications for child mental health. The objective of this paper was to explore the association between maternal depression and child emotional/behavioural difficulties at 4 years postpartum, taking into account earlier episodes of perinatal depression. The Maternal Health Study is a prospective cohort study of 1,507 nulliparous women. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) in early pregnancy and at 3, 6 and 12 months postpartum and again at 4 years postpartum. Maternal depressive symptoms at 4 years postpartum were associated with significantly increased odds of child emotional/behavioural difficulties (odds ratio (OR) = 3.46, 95 % confidence interval (CI) = 2.21-5.43). This remained significant after adjusting for earlier episodes of perinatal depression and socio-demographic characteristics (OR = 2.07, 95 % CI = 1.18-3.63). We also observed a robust association between child difficulties at age 4 and measures of socio-economic disadvantage. Our findings suggest a pressing need to rethink current paradigms of maternal health surveillance and extend mental health surveillance and support to at least 4 years postpartum.

Differentiating maternal fatigue and depressive symptoms at six months and four years post partum: Considerations for assessment, diagnosis and intervention

OBJECTIVE

fatigue and depressive symptoms are common among women in the postpartum period, and it has been proposed that fatigue is a risk factor for later depression. To progress this research, there is a need to clarify the conceptual and measurement issue of whether these two sets of symptoms are distinct constructs. There is also a need to determine whether they are distinct constructs beyond the postnatal period. The aim of the study was to assess the construct and discriminant validity of fatigue and depressive symptoms as measured by the SF-36 Vitality subscale (SF-36) and the Edinburgh Postnatal Depression Scale (EPDS) at six months and at four years post partum.

DESIGN, SETTING AND PARTICIPANTS

data from over 1000 women participating in the Maternal Health Study, a longitudinal study of women׳s physical and psychological health and recovery after childbirth were used.

FINDINGS

confirmatory factor analysis revealed a two-factor model of fatigue and depressive symptoms represented as distinct but related constructs was a better fit to the data than a one-factor model of fatigue and depression sharing the same underlying construct at both six months and four years post partum.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

this study provides empirical evidence that maternal fatigue and depression in the first year after having a baby and at four years post partum are best understood as separate psychological constructs or experiences. The findings have important implications for clinical practice, in particular underlining the importance of differentiating tiredness from depression.

Anthropometric foot changes during pregnancy: a pilot study

BACKGROUND

Women's feet change during pregnancy owing to hormonal and anatomical changes, thus having a strong influence on the decrease in their quality of life during pregnancy. This preliminary study aimed to value the anthropometric and positional changes that affect their feet.

METHODS

Ten pregnant women were measured during their gestational period to analyze the anthropometric changes in their feet from the 12th week of pregnancy. We examined the changes that occured in foot length, forefoot width, arch of the foot height, and the fixed position of the foot by using the Foot Posture Index, and we analyzed three intervals corresponding to pregnancy weeks 12, 24, and 34.

RESULTS

The most significant finding, with a reliability rate of 95%, is the decrease in internal arch height, which descends 0.65 mm (0.0394 inches) on average at the final stage of the pregnancy period. This change happened in 18 of the feet analyzed, tending toward pronation according to the measure provided by the Foot Posture Index, with a change of 3.78 points on this scale.

CONCLUSIONS

The foot of the pregnant woman tends to flatten during gestational weeks 12 to 34, taking a more pronated posture, and the anthropometric changes in late pregnancy result in increases in foot length and forefoot width, changes that seem to be moderate.

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

AIMS

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

BACKGROUND

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

DESIGN

A within-subject comparison was undertaken.

METHODS

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

RESULTS

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

CONCLUSIONS

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

Prediction of maternal quality of life on preterm birth and low birthweight: a longitudinal study

Background

Preterm birth is a significant cause of newborn morbidity and mortality and strains society’s healthcare resources due to its long-term effects on the health of the newborn. Prenatal maternal quality of life (QoL) may be related to the occurrence of preterm birth and low birthweight infants. Few studies, however, have investigated maternal QoL, especially throughout the continuum of pregnancy and the immediate postpartum period. Therefore, the purposes of this longitudinal study were to measure the levels of QoL during and immediately after pregnancy in women with uncomplicated pregnancies, investigate the relationships between the dimensions of QoL, and determine whether prenatal QoL can predict preterm birth and low birthweight.

Methods

Using convenience sampling in one hospital in Taiwan, we recruited 198 pregnant women without pregnancy complications after 24 gestational weeks and followed up monthly until one-month postpartum. The Duke Health Profile was used to measure QoL. Data were analyzed using descriptive statistics, the Mann–Whitney U test, the Kruskal-Wallis test, generalized estimation equations, Pearson correlations, and hierarchical logistic regression.

Results

Pregnant women did not perceive that they had a high level of QoL. Women at late pregnancy experienced a significant decrease in their level of physical and general health. After childbirth, although the mothers had better physical health, they had poorer social health. Poor QoL at late pregnancy predicted preterm birth. Employment, parity, educational level, and happiness about pregnancy were related to prenatal maternal QoL; employment was a factor related to postpartum maternal QoL.

Conclusions

Early assessment of QoL, including its dimensions, of pregnant women may help us to understand women’s health status. Based on this understanding, healthcare professionals can develop interventions to promote pregnant women’s QoL and to lessen the occurrence of preterm birth and low birthweight infants. Further, an emphasis on the positive aspects of pregnancy may increase maternal QoL.

The association between maltreatment in childhood and pre-pregnancy obesity in women attending an antenatal clinic in Australia

Introduction

Obesity in pregnancy is associated with increased risk of complications and adverse outcomes in mother and child. Childhood adverse experiences are known to have numerous negative physical and emotional sequelae. We aimed to examine if exposure to abuse and/or neglect in childhood increased the likelihood of pre-pregnancy obesity.

Methods

Demographic and clinical data including weight, height, mental health as measured by the General Health Questionnaire and exposure to childhood trauma as measured by the childhood trauma questionnaire was collected from 239 women attending antenatal care at an Australian tertiary hospital.

Results

More than one quarter of women were obese prior to pregnancy and approximately 20% of women self reported experiencing moderate to severe physical, sexual or emotional abuse. Almost 60% of women scored in the clinical range on the GHQ. Pre-pregnancy obesity in women attending antenatal care was associated with a self-reported history of emotional or physical abuse with those exposed to moderate or severe emotional or physical abuse having increased odds of being obese prior to pregnancy (O.R. and 95% CI: 2.40; 1.19–4.84 and 2.38; 1.18–4.79 respectively). There was no significant association between other forms of childhood maltreatment, demographic or current mental health status and pre-pregnancy obesity.

Conclusions

The high rates of obesity, mental health problems and self reported childhood maltreatment in the Australian antenatal population are serious public health concerns due to the extra health risks conferred on mother and offspring. Exposure to physical or emotional abuse during childhood increases the likelihood of obesity in women attending antenatal care. Further research is required to determine reasons for this association.