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Aukia L, Paavonen EJ, Karlsson L, Pelto J, Perasto L, Karlsson H, Polo-Kantola P. Sleep duration and sleep loss during pregnancy: a longitudinal FinnBrain birth cohort study. Arch Gynecol Obstet 2024:10.1007/s00404-024-07727-4. [PMID: 39299978 DOI: 10.1007/s00404-024-07727-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 09/04/2024] [Indexed: 09/22/2024]
Abstract
PURPOSE To investigate sleep duration and sleep loss during antenatal period and assess associative factors, including maternal characteristic and mood symptoms. METHODS A cohort of 3038 women was enrolled. Self-reported sleep duration and sleep loss, the latter being calculated from preferred sleep need and actual sleep duration, were measured in early, mid- and late pregnancy, and at delivery. The associations with age, BMI, parity, education, smoking, napping, and depressive and anxiety symptoms were evaluated. RESULTS Sleep duration was longest in early pregnancy and shortest at delivery (7.93 h-7.76 h, p < 0.001). The proportion of short sleepers (< 6 h) increased from 1.4% to 5.9% throughout the studied period (p < 0.001). Mean sleep loss remained stable in early- and mid-pregnancy, lowering in late pregnancy (p < 0.001) and increasing again until delivery (p = 0.003). The number of women with notable sleep loss (> 2 h) was similar during the first three measurement points (9.4%, 8.9% and 9.5%), but increased until delivery (14.1%, p < 0.001). Older, multiparous, and more-depressive women slept less (p < 0.001, p < 0.001, p = 0.017). Women with higher BMI were more likely to sleep < 6 h in late pregnancy (p = 0.012). Multiparous, more-depressive, and higher-BMI women reported more sleep loss (p < 0.001, p < 0.001, p = 0.049). CONCLUSION We confirmed earlier reported decrease in sleep duration at the end of pregnancy. As a novel finding, we showed a notable increase in sleep loss during the last month of pregnancy. Various factors were associated with both short sleep and sleep loss, especially multiparity, napping and depressive symptoms.
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Affiliation(s)
- Linda Aukia
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Savitehtaankatu 5, 20520, Turku, Finland.
| | - E Juulia Paavonen
- Pediatric Research Center, Child Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
| | - Juho Pelto
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Laura Perasto
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
| | - Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Savitehtaankatu 5, 20520, Turku, Finland
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Luoma I, Korhonen M, Salmelin RK, Siirtola A, Mäntymaa M, Valkonen-Korhonen M, Puura K. Mothers' and their children's emotional and behavioral symptom trajectories and subsequent maternal adjustment: Twenty-seven years of motherhood. J Affect Disord 2024; 361:299-309. [PMID: 38876318 DOI: 10.1016/j.jad.2024.06.027] [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: 10/25/2023] [Revised: 04/30/2024] [Accepted: 06/11/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND This study aims to describe maternal depressive symptoms (MDS) trajectories in a longitudinal study extending from pregnancy to 27 years after the birth of the firstborn child. We also explored the associations of both MDS trajectories and child internalizing and externalizing problem trajectories with maternal adjustment (adaptive functioning, emotional and behavioral problems). METHODS The population-based study was conducted in Tampere, Finland, and the sample comprised 356 first-time mothers. MDS were screened with the Edinburgh Postnatal Depression Scale during pregnancy, first week after delivery, 2 and 6 months postnatally, and when the child was 4-5, 8-9, 16-17, and 26-27 years of age. The internalizing and externalizing problems of the children were assessed with the Child Behavior Checklist when the child was 4-5, 8-9, and 16-17 years of age. Maternal adaptive functioning and internalizing and externalizing problems were assessed with the Adult Self Report at 26-27 years after the birth of the first child. Complete follow-up data were available for 168 mothers. RESULTS We describe a three-group trajectory model of MDS (High Stable, Low Stable, Very Low). Elevated depressive symptom patterns were associated with less optimal maternal outcomes regarding both adaptive and problem dimensions. The child's internalizing and externalizing problem trajectories were associated with maternal internalizing and externalizing problems but not with maternal adaptive functioning. LIMITATIONS Maternal and child measures were based on maternal reports only. CONCLUSIONS The interconnectedness of the well-being of the mother and child should be noted in health and mental health services for adults and children.
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Affiliation(s)
- Ilona Luoma
- University of Eastern Finland, Faculty of Health Sciences, Kuopio, Finland; Kuopio University Hospital, Department of Child Psychiatry, Kuopio, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
| | - Marie Korhonen
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; Helsinki University Hospital, Department of Child Psychiatry, Helsinki, Finland
| | - Raili K Salmelin
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; Tampere University Hospital, Department of Child Psychiatry, Tampere, Finland
| | - Arja Siirtola
- Tampere University Hospital, Department of Child Psychiatry, Tampere, Finland
| | - Mirjami Mäntymaa
- University of Oulu, Faculty of Medicine, Oulu, Finland; Oulu University Hospital, Department of Child Psychiatry, Oulu, Finland
| | - Minna Valkonen-Korhonen
- University of Eastern Finland, Faculty of Health Sciences, Kuopio, Finland; Kuopio University Hospital, Department of Psychiatry, Kuopio, Finland
| | - Kaija Puura
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; Tampere University Hospital, Department of Child Psychiatry, Tampere, Finland
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Wasti P, Panta PP, Gc VS, Ghimire B, Sapkota P, Wasti SP. Prevalence of Perinatal Depression and Its Associated Risk Factors among Nepalese Women in Kathmandu, Nepal. Healthcare (Basel) 2024; 12:1773. [PMID: 39273797 PMCID: PMC11395621 DOI: 10.3390/healthcare12171773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/28/2024] [Accepted: 09/03/2024] [Indexed: 09/15/2024] Open
Abstract
Perinatal mental health is a major public health issue that arises during pregnancy and/or after birth, with substantial implications for social, parental, and maternal functioning, as well as overall quality of life. The study aimed to determine the prevalence of perinatal depression and its associated risk factors among women who visited a maternity hospital in Kathmandu, Nepal. A cross-sectional study was conducted at the Paropakar Maternity and Women's Hospital in Kathmandu. A total of 300 women in their perinatal period were interviewed. The Edinburgh Perinatal Depression Scale (EPDS) was used to measure perinatal depression. The Poisson regression model was used to determine risk factors associated with perinatal depression. The mean age of respondents was 25.5 (SD 4.5) years; average age during their first pregnancy was 23.5 (SD 3.7) years; and 53.7% of respondents were in the antenatal period. The prevalence of depressive symptoms (EPDS ≥ 10) was 40% (95% CI 31.4% to 45.8%). Unsupportive family members (adjusted prevalence ratio [aPR] 2.23; 95% CI 1.75-2.86), postnatal period (aPR 2.64; 95% CI 1.97-3.53), complications faced during delivery (aPR 1.76; 95%CI 1.30-2.39), history of intimate partner violence (aPR 0.48; 95% CI 0.36-0.64), and first pregnancy at the age of ≤25 years (aPR 0.61; 95% CI 0.42-0.88) were identified as key risk factors of perinatal depression. Strong family support and the active involvement of partners in counselling can contribute to alleviating perinatal depression symptoms. Targeted interventions in health and well-being services should be implemented to address mental health burden during both pregnancy and postpartum periods.
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Affiliation(s)
- Pratikshya Wasti
- Department of Public Health, Nobel College, Kathmandu 44600, Nepal
| | | | - Vijay S Gc
- School of Human and Health Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Biwash Ghimire
- College of Pharmacy, Idaho State University, Pocatello, ID 83209, USA
| | - Pooja Sapkota
- College of Pharmacy, Idaho State University, Pocatello, ID 83209, USA
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Gallego-Gómez C, Rodríguez-Gutiérrez E, Torres-Costoso A, Martínez-Vizcaíno V, Martínez-Bustelo S, Quezada-Bascuñán CA, Ferri-Morales A. Urinary incontinence increases risk of postpartum depression: systematic review and meta-analysis. Am J Obstet Gynecol 2024; 231:296-307.e11. [PMID: 38437894 DOI: 10.1016/j.ajog.2024.02.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE Postpartum depression is one of the most common complications after childbearing. Urinary incontinence is a frequent symptom during pregnancy and the postnatal period, often being the first time that women experience it. This systematic review and meta-analysis aimed to synthesize the evidence on the association between urinary incontinence and postpartum depression and to assess whether this association becomes weaker at 6 months after childbirth. DATA SOURCES MEDLINE, Embase, Cochrane Library, Web of Science, and PsycINFO were searched from inception to December 26, 2023. STUDY ELIGIBILITY CRITERIA Cross-sectional and cohort studies addressing the association between urinary incontinence and postpartum depression were included. METHODS Pooled odds ratios and their 95% confidence intervals, and 95% prediction intervals were estimated using a DerSimonian and Laird random-effects model for the association between urinary incontinence and postpartum depression. Subgroup analyses were conducted on the basis of time after delivery (<6 or ≥6 months). The risk of bias was assessed with the National Institutes of Health Quality Assessment Tool for Observational Cohort Studies. RESULTS Eleven published studies were included in the systematic review and meta-analysis. Overall, the odds ratio for the association between urinary incontinence and postpartum depression was 1.45 (95% confidence interval, 1.11-1.79; 95% prediction interval, 0.49-2.40; I2=65.9%; P=.001). For the 7 cohort studies, the odds ratio was 1.63 (95% confidence interval, 1.35-1.91; 95% prediction interval, 1.14-2.13; I2=11.1%; P=.345). For the 4 cross-sectional studies, the odds ratio was 1.05 (95% confidence interval, 1.04-1.05; 95% prediction interval, 1.04-1.06; I2=0.0%; P=.413). According to the time after delivery, the odds ratio estimates for cohort studies with a postpartum period <6 months were 1.44 (95% confidence interval, 1.07-1.81; prediction interval, 0.63-2.25; I2=0.0%; P=.603) and 1.53 (95% confidence interval, 1.16-1.89; prediction interval, 0.41-2.65; I2=50.7%; P=.087) for those with a postpartum period ≥6 months. CONCLUSION This systematic review and meta-analysis suggests that urinary incontinence may be a potential predictor of postpartum depression. Thus, it is important that health care professionals offer support and treatment options to women who experience these conditions.
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Affiliation(s)
- Cristina Gallego-Gómez
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, Spain; Physiotherapy Unit, Health Center of Camarena, Toledo, Spain; Toledo Physiotherapy Research Group (GIFTO), University of Castilla-La Mancha, Toledo, Spain
| | | | - Ana Torres-Costoso
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, Spain; Health and Social Research Center, University of Castilla-La Mancha, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, University of Castilla-La Mancha, Cuenca, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Sandra Martínez-Bustelo
- Psychosocial Intervention and Functional Rehabilitation Research Group, Faculty of Physiotherapy, University of A Coruña, A Coruña, Spain
| | | | - Asunción Ferri-Morales
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, Spain; Health and Social Research Center, University of Castilla-La Mancha, Cuenca, Spain
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Scroggins JK, Topaz M, Min SH, Barcelona V. Associations Among Lifetime Discrimination Typologies and Psychological Health in Black and Hispanic Women After Birth. J Obstet Gynecol Neonatal Nurs 2024:S0884-2175(24)00258-2. [PMID: 39197482 DOI: 10.1016/j.jogn.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 07/15/2024] [Accepted: 07/25/2024] [Indexed: 09/01/2024] Open
Abstract
OBJECTIVE To identify lifetime discrimination typologies and examine their associations with psychological health outcomes among Black and Hispanic women after birth. DESIGN Secondary analysis of the Community and Child Health Network study data. PARTICIPANTS A total of 1,350 Black and 607 Hispanic women. METHODS We built two latent class models for Black and Hispanic women using eight indicator variables from different life domains of discrimination (childhood, family, work, police, education, housing, health care, and loans). We used bivariate and multiple regression analyses to examine the association among the identified typologies and postpartum depression and perceived stress at 6 months postpartum. RESULTS We selected the three-class model with best fit indices and interpretability: no lifetime discrimination (n = 1,029; 76.22%), high childhood-family racial discrimination (n = 224, 16.59%), and moderate lifetime discrimination (n = 97, 7.19%) among Black women and no lifetime discrimination (n = 493, 81.22%), high childhood-family racial discrimination (n = 93, 15.32%), and high education discrimination (n = 21, 3.46%) among Hispanic women. The adjusted postpartum depression and perceived stress scores were significantly greater in Typologies 2 and 3 than Typology 1 in Black women. The adjusted perceived stress scores were significantly greater in Typologies 2 and 3 than Typology 1 in Hispanic women. CONCLUSION Lifetime discrimination experiences manifested in complex patterns. Women who experienced moderate to high discrimination across all or specific life domains had worse postpartum depression and perceived stress at 6 months after birth. It is crucial to address lifetime discrimination to improve maternal mental health.
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La Verde M, Luciano M, Fordellone M, Brandi C, Carbone M, Di Vincenzo M, Lettieri D, Palma M, Marrapodi MM, Scalzone G, Torella M. Is there a correlation between prepartum anaemia and an increased likelihood of developing postpartum depression? A prospective observational study. Arch Gynecol Obstet 2024; 310:1099-1108. [PMID: 38345767 PMCID: PMC11258048 DOI: 10.1007/s00404-023-07344-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/12/2023] [Indexed: 07/19/2024]
Abstract
PURPOSE Postpartum depression (PPD) represents a significant challenge to maternal and child health. Early screening for PPD is essential to ensure appropriate treatment and support. The present study aimed to assess whether maternal prepartum anaemia influences the likelihood of developing PPD within 3 days after delivery. METHODS In collaboration with the Department of Psychiatry, a prospective observational study was carried out at the Gynaecology and Obstetrics Department of the University of Campania "Luigi Vanvitelli" in Naples. A total of 211 full-term pregnant women were enrolled, and their predelivery haemoglobin value was recorded. Women with gestational diabetes, hypertension, pre-eclampsia, intrauterine growth restriction, intellectual disability, or pre-existing diagnosis of psychotic spectrum disorder were excluded. Participants provided written informed consent to fill out the Edinburgh Postnatal Depression Scale (EPDS) 3 days after delivery. EPDS cut-off score of ≥ 10 was used to identify women at risk of developing PPD. Statistical analysis was performed using Student's t test, the Wilcoxon Rank Sum test, and linear regression. RESULTS The participants were categorized into 2 groups based on EPDS scores: EPDS < 10 (176 patients) or EPDS ≥ 10 (35 patients). The two groups showed homogeneity in terms of socio-demographic and clinical characteristics. The mean haemoglobin values of anaemic pregnant women in the EPDS ≤ 10 group (11.78 ± 1.39 g/dl) and the EPDS > 10 group (11.62 ± 1.27 g/dl) were not significantly different (p = 0.52). There was no significant correlation between the predelivery haemoglobin value and the EPDS postpartum score of < 10 or ≥ 10. The Wilcoxon Rank Sum test and the estimated coefficients of the linear regression model did not show any statistical relationship between continuous and binary haemoglobin values. CONCLUSIONS Our study found that maternal prepartum anaemia did not negatively impact the likelihood of developing postpartum depressive symptoms, in the first 3 days after delivery.
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Affiliation(s)
- Marco La Verde
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania, "L. Vanvitelli", Naples, Italy
| | - Mario Fordellone
- Medical Statistics Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Carlotta Brandi
- Department of Psychiatry, University of Campania, "L. Vanvitelli", Naples, Italy
| | - Marco Carbone
- Department of Psychiatry, University of Campania, "L. Vanvitelli", Naples, Italy
| | - Matteo Di Vincenzo
- Department of Psychiatry, University of Campania, "L. Vanvitelli", Naples, Italy
| | - Davide Lettieri
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marica Palma
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Maddalena Marrapodi
- Department of Woman, Child and General and Specialized Surgery, Pediatric Unit, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Gaetano Scalzone
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
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Zacher Kjeldsen MM, Mægbæk ML, Liu X, Madsen MG, Bliddal M, Egsgaard S, Bang Madsen K, Munk-Olsen T. The HOPE cohort: cohort profile and evaluation of selection bias. Eur J Epidemiol 2024; 39:943-954. [PMID: 39158818 PMCID: PMC11410971 DOI: 10.1007/s10654-024-01150-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 08/07/2024] [Indexed: 08/20/2024]
Abstract
The HOPE cohort is a Danish nationwide cohort with ongoing follow-up, holding information on postpartum depression (PPD) symptoms and diagnoses on 170,218 childbirths (142,795 unique mothers). These data have been linked with extensive register data on health and socioeconomic information on the mothers, their partners, parents, and children. This cohort profile aimed to provide an overview of the data collection and content, describe characteristics, and evaluate potential selection bias. PPD screenings, using the Edinburgh Postnatal Depression Scale, were collected from 67 of the 98 Danish municipalities, covering the period January 2015 to December 2021. This data was linked with register data on PPD diagnoses (identified through medication prescriptions and hospital contacts) as well as background information. Cohort characteristics were compared to the source population, defined as all childbirths by women residing in Denmark during the same period (452,207 childbirths). Potential selection bias was evaluated by comparing odds ratios of five well-established associations between the cohort and the source population. The HOPE cohort holds information on 170,218 childbirths (38% of the source population) involving 142,795 unique mothers. The HOPE cohort only differed slightly from the source population on most characteristics examined, but larger differences were observed on specific characteristics with an underrepresentation of the youngest and oldest age groups, women with more than three children or twins/triplets, and women born outside Denmark. Similar associations were identified across the two populations within the five well-established associations. There was no indication of selection bias on the five examined associations, and the HOPE cohort is representative of the source population on important perinatal characteristics.
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Affiliation(s)
- Mette-Marie Zacher Kjeldsen
- NCRR-National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark.
- Department of Public Health, Aarhus University, Aarhus, Denmark.
- CIRRAU - Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark.
| | - Merete Lund Mægbæk
- NCRR-National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- CIRRAU - Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Xiaoqin Liu
- NCRR-National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- CIRRAU - Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Malene Galle Madsen
- NCRR-National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Mette Bliddal
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sofie Egsgaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Psychiatric Unit, Region of Southern Denmark, Odense, Denmark
| | - Kathrine Bang Madsen
- NCRR-National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- CIRRAU - Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Trine Munk-Olsen
- NCRR-National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Psychiatric Unit, Region of Southern Denmark, Odense, Denmark
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Wang J, Huang Y, Wu L, Sun Y, Zhang X, Cao F. Sleep-specific repetitive negative thinking processes and prenatal insomnia symptoms: A naturalistic follow-up study from mid- to late-pregnancy. J Sleep Res 2024:e14272. [PMID: 39021269 DOI: 10.1111/jsr.14272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/04/2024] [Accepted: 06/03/2024] [Indexed: 07/20/2024]
Abstract
Insomnia symptoms are highly prevalent during pregnancy; therefore, identifying modifiable risk markers is important for risk prediction and early intervention. This study aimed to examine the role of sleep-specific rumination and sleep-specific worry in prenatal insomnia symptoms. A total of 859 married pregnant women without history of psychiatric illnesses (mean [standard deviation] age, 30.15 [3.86] years; 593 [69.0%] with a bachelor's degree or above) were enrolled from the obstetrical outpatient departments of two tertiary comprehensive hospitals in Shandong, China, who completed assessments of sleep-specific rumination, sleep-specific worry, and insomnia symptoms at baseline (mid-pregnancy) and follow-up (late-pregnancy). Measures included Daytime Insomnia Symptom Response Scale, Anxiety and Preoccupation about Sleep Questionnaire, and Insomnia Severity Index. Our results showed that after controlling for covariates, both sleep-specific rumination and sleep-specific worry showed significant concurrent and prospective associations with insomnia symptoms, and the increases in scores of sleep-specific rumination and sleep-specific worry over time were significantly associated with the increased likelihood of insomnia symptoms at follow-up. Moreover, the increases in sleep-specific rumination and sleep-specific worry over time were significantly associated with the increased likelihood of reporting newly developed insomnia symptoms rather than persistent normal sleep. However, the changes in sleep-specific rumination and sleep-specific worry were not significantly associated with the likelihood of reporting persistent or remitted insomnia symptoms rather than persistent normal sleep. In conclusion, sleep-specific rumination and sleep-specific worry were significantly associated with concurrent or subsequent insomnia symptoms; thus, they may be promising cognitive risk markers and intervention targets.
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Affiliation(s)
- Juan Wang
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital and School of Brain Science and Brain Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, MOE Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-machine Intelligence, Zhejiang University, Hangzhou, China
- NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University, Hangzhou, China
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yongqi Huang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Liuliu Wu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yaoyao Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
| | - Xuan Zhang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fenglin Cao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
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Wyunn KM, Than Wai ZZ, Ei Swe KE, Inthaphatha S, Nishino K, Yamamoto E. Factors associated with postpartum depression among Myanmar women in Yangon: A cross-sectional study. Heliyon 2024; 10:e33425. [PMID: 39040339 PMCID: PMC11261082 DOI: 10.1016/j.heliyon.2024.e33425] [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: 04/12/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 07/24/2024] Open
Abstract
Background Postpartum depression (PPD) is non-psychotic depressive illness after childbirth, and PPD affects the health and social status of mothers and their children. This study aims to identify the prevalence of suspected PPD and associated factors among women in Yangon, Myanmar. Methods This is a cross-sectional study of 552 women at 6-8 weeks postpartum who visited at North Okkalapa General and Teaching Hospital for postnatal care from September to October 2022. Socio-demographic factors, obstetric and infant factors, family support, and medical history were collected using a structured questionnaire. Myanmar version of the Edinburgh Postnatal Depression Scale (EPDS) was used for screening PPD, and all women were divided into suspected PPD (EPDS ≥10) and non-suspected PPD (EPDS <10). Chi-square and Fisher's exact tests were used to compare the characteristics of women between suspected PPD and non-suspected PPD. Logistic regression analysis was preformed to identify the factors associated with suspected PPD. Results The mean age of the 552 women was 27.9 years and 176 women (31.9 %) were categorized into suspected PPD. Factors associated with suspected PPD were living in a nuclear family (adjusted odds ratio (AOR) = 2.04, 95 % confidence interval (CI) 1.10-3.77), feeling insufficient income (AOR = 2.15, 95 % CI 1.09-4.25), unplanned pregnancy (AOR = 2.76, 95 % CI 1.47-5.16), less than eight ANC visits (AOR = 3.29, 95 % CI 1.74-6.23), low birth weight of the last baby (AOR = 5.69, 95 % CI 1.17-27.71), insufficient support from partners (AOR = 11.28, 95 % CI 5.62-22.63), parents (AOR = 3.83, 95 % CI 2.08-7.04), and parents-in-law (AOR = 2.00, 95 % CI 1.06-3.76), and depressive symptoms during the last pregnancy (AOR = 3.08, 95 % CI 1.52-6.26). Conclusion The prevalence of suspected PPD was 31.9 % among 6-8-week postpartum women in Yangon. Strengthening maternal health programs and providing education about postpartum psychiatric problems is essential to improve maternal psychological well-being.
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Affiliation(s)
- Kaung Myat Wyunn
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Medical Services, Ministry of Health, Nay Pyi Taw, Myanmar
| | | | - Khin Ei Ei Swe
- North Okkalapa General and Teaching Hospital, Yangon, Myanmar
| | - Souphalak Inthaphatha
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Asian Satellite Campuses Institute, Nagoya University, Nagoya, Japan
| | - Kimihiro Nishino
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Puosi E, Karlsson H, Lukkarinen H, Karlsson L, Lukkarinen M. Paternal adverse childhood experiences are associated with a low risk of atopy in the offspring. Acta Paediatr 2024. [PMID: 38992923 DOI: 10.1111/apa.17345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/13/2024]
Abstract
AIM Parental adverse childhood experiences (ACE) might affect the offspring health through intergenerational inheritance. The aim of this study was to investigate how paternal ACE associate with offspring sensitisation and allergic rhinitis (AR). METHODS The study included 590 Finnish father-child dyads from the FinnBrain Birth Cohort Study. Outcomes were offspring sensitisation against allergens and AR at age 5.5 years. Paternal ACE up to 18 years were assessed using the Trauma and Distress Scale (TADS) with the lowest quarter as the reference group. RESULTS Of the children, 317 (54%) were males. Sensitisation occurred in 162/533 (30%) and AR in 122/590 (21%). Paternal TADS (median 17 points; interquartile range 11-27) was inversely associated with the risk of sensitisation. Children whose fathers scored the highest quarter had the lowest risk of sensitisation (adjusted odds ratio 0.42; 95% confidence interval 0.24-0.75), followed by those in the second highest quarter (0.58; 0.34-0.99). The association between the highest quarter and reduced risk of AR was similar. CONCLUSION Paternal ACE were associated with a low risk of offspring sensitisation and AR, suggesting paternal childhood stress might influence immune responses in their offspring.
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Affiliation(s)
- Emma Puosi
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- Tyks Department of Paediatrics and Adolescent Medicine, Turku University Hospital and Paediatrics and Adolescent Medicine, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku and Tyks Psychiatry, Turku University Hospital, Turku, Finland
| | - Heikki Lukkarinen
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- Tyks Department of Paediatrics and Adolescent Medicine, Turku University Hospital and Paediatrics and Adolescent Medicine, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- Tyks Department of Paediatrics and Adolescent Medicine, Turku University Hospital and Paediatrics and Adolescent Medicine, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Minna Lukkarinen
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- Tyks Department of Paediatrics and Adolescent Medicine, Turku University Hospital and Paediatrics and Adolescent Medicine, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
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11
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Si S, Zhao G, Song G, Liu J. Assisted reproductive technologies and postpartum depressive symptoms: A meta-analysis. J Affect Disord 2024; 356:300-306. [PMID: 38583599 DOI: 10.1016/j.jad.2024.03.168] [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: 03/07/2023] [Revised: 03/08/2024] [Accepted: 03/29/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Assisted reproductive technologies (ARTs) have become the main treatment for infertility. ART treatment can be a stressful life event for infertile females. Whether there is an association between ARTs and postpartum depressive symptoms (PDS) has not been established. METHODS PubMed, MEDLINE, EMBASE, PsycINFO, and CNKI were searched. The pooled outcome was the difference in incidence of PDS within 1 year postpartum between ARTs and the spontaneous pregnancy group. RESULTS A total of 12 cohort studies, which were conducted in eight developed countries and two developing countries, were involved. In total, 106,338 pregnant women, including 4990 infertile females with ARTs treatment and 101,348 women with spontaneous pregnancy, were enrolled in our final analysis. ARTs women had a lower incidence of PDS compared to the spontaneous pregnancy group according to a random effect model (OR = 0.83, 95 % CI: 0.71-0.97, p = 0.022, I2 = 62.0 %). Subgroup analyses indicated that studies on late PDS (follow-up: 3-12 months postpartum) were more heterogeneous than those on early PDS (follow-up: <3 months postpartum) (I2 = 24.3 % vs. I2 = 0 %, interaction p-value < 0.001). There was a strong relationship between ARTs and late PDS (OR = 0.65, 95 % CI: 0.55-0.77, p < 0.001). Therefore, the possible source of heterogeneity was the postpartum evaluation time, which was confirmed by post-hoc meta-regression. LIMITATIONS Some underlying confounders, such as previous psychiatric illness, the limited availability of ARTs, and ethnic disparities, cannot be ignored and may have biased interpretation of the results. CONCLUSION The available data suggested that ARTs were associated with lower incidence of PDS, especially when follow-up lasted over 3 months. However, these findings should be interpreted with caution. Better-designed trials are needed to confirm this association.
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Affiliation(s)
- Si Si
- Department of Obstetrics, The First Hospital of China Medical University, Shenyang, China
| | - Ge Zhao
- Department of Obstetrics, The First Hospital of China Medical University, Shenyang, China
| | - Guang Song
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Liu
- Department of Obstetrics, The First Hospital of China Medical University, Shenyang, China.
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12
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Garbazza C, Mangili F, D'Onofrio TA, Malpetti D, Riccardi S, Cicolin A, D'Agostino A, Cirignotta F, Manconi M. A machine learning model to predict the risk of perinatal depression: Psychosocial and sleep-related factors in the Life-ON study cohort. Psychiatry Res 2024; 337:115957. [PMID: 38788556 DOI: 10.1016/j.psychres.2024.115957] [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: 09/22/2023] [Revised: 05/06/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
Perinatal depression (PND) is a common complication of pregnancy associated with serious health consequences for both mothers and their babies. Identifying risk factors for PND is key to early detect women at increased risk of developing this condition. We applied a machine learning (ML) approach to data from a multicenter cohort study on sleep and mood changes during the perinatal period ("Life-ON") to derive models for PND risk prediction in a cross-validation setting. A wide range of sociodemographic variables, blood-based biomarkers, sleep, medical, and psychological data collected from 439 pregnant women, as well as polysomnographic parameters recorded from 353 women, were considered for model building. These covariates were correlated with the risk of future depression, as assessed by regularly administering the Edinburgh Postnatal Depression Scale across the perinatal period. The ML model indicated the mood status of pregnant women in the first trimester, previous depressive episodes and marital status, as the most important predictors of PND. Sleep quality, insomnia symptoms, age, previous miscarriages, and stressful life events also added to the model performance. Besides other predictors, sleep changes during early pregnancy should therefore assessed to identify women at higher risk of PND and support them with appropriate therapeutic strategies.
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Affiliation(s)
- Corrado Garbazza
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Lugano, Switzerland; Centre for Chronobiology, University of Basel, Basel, Switzerland; Research Cluster Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland.
| | - Francesca Mangili
- Istituto Dalle Molle di Studi sull'Intelligenza Artificiale (IDSIA), USI/SUPSI, Lugano, Switzerland
| | - Tatiana Adele D'Onofrio
- Istituto Dalle Molle di Studi sull'Intelligenza Artificiale (IDSIA), USI/SUPSI, Lugano, Switzerland
| | - Daniele Malpetti
- Istituto Dalle Molle di Studi sull'Intelligenza Artificiale (IDSIA), USI/SUPSI, Lugano, Switzerland
| | - Silvia Riccardi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Alessandro Cicolin
- Sleep Medicine Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Armando D'Agostino
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | | | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
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13
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Baattaiah BA, Alharbi MD, Aldhahi MI, Khan F. Factors associated with postpartum fatigue: an exploration of the moderating role of resilience. Front Public Health 2024; 12:1394380. [PMID: 38947349 PMCID: PMC11211369 DOI: 10.3389/fpubh.2024.1394380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/04/2024] [Indexed: 07/02/2024] Open
Abstract
Background Postpartum fatigue (PPF) can impair the physical and mental well-being of women. The aims of this study were to assess the associations between fatigue and maternal health-related variables, specifically, sleep quality, depression symptoms, and resilience, and to explore the moderating role of resilience in the relationships between sleep quality, depression symptoms, and fatigue. Methods This cross-sectional study used data collected from mothers during the postpartum period via an online platform. PPF was assessed using the Fatigue Severity Scale, whereas sleep quality and depression symptoms were assessed using the Pittsburgh Sleep Quality Index and Edinburgh Postnatal Depression Scale, respectively. The Brief Resilience Scale was used to assess resilience. Simple and multiple binary logistic regression analyses were performed to examine the association of each independent variable with PPF and to determine the most significant predictors of PFF. The data were analyzed using SPSS, and structural equation modeling was performed using AMOS 23. A moderation analysis was performed to explore the moderating role of resilience using the Hayes PROCESS macro. Results A total of 1,443 postpartum mothers were included in the analysis. The simple binary logistic regression analysis showed that having chronic disease (odds: 1.52; p = 0.02), mother's age (odds: 0.97; p = 0.03), mother's body mass index (BMI; odds: 1.03; p = 0.01), depression symptoms (odds: 1.09; p ≤ 0.0001), sleep quality (odds: 1.17; p ≤ 0.0001), and resilience (odds: 0.42; p ≤ 0.0001) all contributed to fatigue during postpartum. Multivariate logistic regression showed that the mother's BMI, sleep quality, depression symptoms, and resilience were significant predictors of PPF. Moderation analyses showed that resilience was not a significant moderator between the main effects of sleep quality and fatigue (interaction effect: β = 0.01, p = 0.31, 95% CI: -0.01 to 0.04) or between the main effects of depression symptoms and fatigue during postpartum (interaction effect: β = 0.01, p = 0.82, 95% CI: -0.01 to 0.02). Conclusion Given the deleterious effects of PPF on maternal health outcomes, factors associated with PPF should be assessed regularly. In addition to mothers' BMI, sleep quality, and depression symptoms, resilience could also be a crucial factor in predicting fatigue severity during this critical time for mothers even though it was not a significant moderator among this sample.
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Affiliation(s)
- Baian A. Baattaiah
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mutasim D. Alharbi
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Monira I. Aldhahi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Fayaz Khan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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14
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Thamby A, Bajaj A, L M, G SK, Gr G, K T, Ts J. Impaired mother-infant bonding: a community study from India. J Reprod Infant Psychol 2024; 42:528-539. [PMID: 36138562 DOI: 10.1080/02646838.2022.2125938] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Impaired mother-infant bonding (MIB) is associated with inadequate maternal skills and pose a higher risk for impaired learning, child abuse, and psychiatric disorders in children. There are approximately 24 million births annually in India; however, community data on MIB from India is lacking. METHODS The study reports the findings of a cross-sectional survey of 8189 mothers with children of age between 13 and 15 months from the state of Kerala, India. Bonding was assessed using the Mother-infant bonding scale (MIBS). Other correlates assessed include obstetric and birth history, chronic pain, postpartum depression and temperamental issues in the infant. RESULTS The prevalence of impaired MIB in our sample was 12.3%. Those in extended/joint family, experiencing postpartum complications, supplementary breastfeeding in the first 6 months, postpartum depression and temperamental issues in infant were found to be associated with increased MIBS scores in a multivariate mixed-effect zero-inflated poisson model. CONCLUSION Experience of impaired MIB is not uncommon among mothers in India. More needs to be done to explore these issues, especially among those with higher risk to ensure appropriate interventions to mitigate long-term consequences.
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Affiliation(s)
- Abel Thamby
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Aakash Bajaj
- Department of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Manoj L
- National Health Mission (Kerala), Thiruvananthapuram, India
| | - Sunil Kumar G
- National Health Mission (Kerala), Thiruvananthapuram, India
| | - Gokul Gr
- National Health Mission (Kerala), Thiruvananthapuram, India
| | - Thennarasu K
- Department of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Jaisoorya Ts
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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15
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Ferris D, Roll S, Huang J, Mathews K, Ragain T, Simpson K, Jabbari J, Gilbert K, Frank T. Improving Maternal Health and Birth Outcomes Through FreshRx: A Food-Is-Medicine Intervention. Am J Health Promot 2024:8901171241249278. [PMID: 38670549 DOI: 10.1177/08901171241249278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
PURPOSE Food insecurity has far-reaching consequences for health and well-being, especially during pregnancy and postpartum periods. This study examines a food-is-medicine approach that aimed to reduce food insecurity, maternal stress, depression, anxiety, preterm labor, and low birthweight. DESIGN Pre-post interventional study of FreshRx: Nourishing Healthy Starts, a pregnancy focused food-is-medicine program led by a local hunger relief organization and obstetrics department. SETTING St. Louis, Missouri, a Midwestern U.S. city with higher-than-average infant mortality, low birthweight, and preterm birth rates. SAMPLE Participants (N = 125) recruited from a local obstetrics clinic had pregnancies earlier than 24 weeks gestation; spoke English; and were enrolled in Medicaid. At baseline, 67.0% reported very low food security and none reported high food security, while 34.7% indicated depressive symptoms. INTERVENTION FreshRx included weekly deliveries of fresh food meal kits, nutrition counseling and education, care coordination, and supportive services. MEASURES 18-Question U.S. Household Food Security Survey, Edinburgh Postnatal Depression Scale, birthweight, gestational age. ANALYSIS Single arm pre-post analysis. RESULTS Average gestational age of 38.2 weeks (n = 84) and birthweight of 6.7 pounds (n = 81) were higher than rates for the general population in the area. For study participants who completed a sixty-day post-partum assessment, 13% (n = 45) indicated maternal depression (P < .01). CONCLUSION Food-is-medicine interventions may be an efficient, effective, and equitable tool for improving birth and maternal health outcomes.
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Affiliation(s)
- Dan Ferris
- Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Stephen Roll
- Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Jin Huang
- College for Public Health and Social Work, Saint Louis University, Saint Louis, MO, USA
| | - Katherine Mathews
- Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | | | | | - Jason Jabbari
- Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Kourtney Gilbert
- Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Tyler Frank
- Brown School at Washington University in St. Louis, St. Louis, MO, USA
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Wang S, Deng CM, Zeng Y, Chen XZ, Li AY, Feng SW, Xu LL, Chen L, Yuan HM, Hu H, Yang T, Han T, Zhang HY, Jiang M, Sun XY, Guo HN, Sessler DI, Wang DX. Efficacy of a single low dose of esketamine after childbirth for mothers with symptoms of prenatal depression: randomised clinical trial. BMJ 2024; 385:e078218. [PMID: 38808490 DOI: 10.1136/bmj-2023-078218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
OBJECTIVE To determine whether a single low dose of esketamine administered after childbirth reduces postpartum depression in mothers with prenatal depression. DESIGN Randomised, double blind, placebo controlled trial with two parallel arms. SETTING Five tertiary care hospitals in China, 19 June 2020 to 3 August 2022. PARTICIPANTS 364 mothers aged ≥18 years who had at least mild prenatal depression as indicated by Edinburgh postnatal depression scale scores of ≥10 (range 0-30, with higher scores indicating worse depression) and who were admitted to hospital for delivery. INTERVENTIONS Participants were randomly assigned 1:1 to receive either 0.2 mg/kg esketamine or placebo infused intravenously over 40 minutes after childbirth once the umbilical cord had been clamped. MAIN OUTCOME MEASURES The primary outcome was prevalence of a major depressive episode at 42 days post partum, diagnosed using the mini-international neuropsychiatric interview. Secondary outcomes included the Edinburgh postnatal depression scale score at seven and 42 days post partum and the 17 item Hamilton depression rating scale score at 42 days post partum (range 0-52, with higher scores indicating worse depression). Adverse events were monitored until 24 hours after childbirth. RESULTS A total of 364 mothers (mean age 31.8 (standard deviation 4.1) years) were enrolled and randomised. At 42 days post partum, a major depressive episode was observed in 6.7% (12/180) of participants in the esketamine group compared with 25.4% (46/181) in the placebo group (relative risk 0.26, 95% confidence interval (CI) 0.14 to 0.48; P<0.001). Edinburgh postnatal depression scale scores were lower in the esketamine group at seven days (median difference -3, 95% CI -4 to -2; P<0.001) and 42 days (-3, -4 to -2; P<0.001). Hamilton depression rating scale scores at 42 days post partum were also lower in the esketamine group (-4, -6 to -3; P<0.001). The overall incidence of neuropsychiatric adverse events was higher in the esketamine group (45.1% (82/182) v 22.0% (40/182); P<0.001); however, symptoms lasted less than a day and none required drug treatment. CONCLUSIONS For mothers with prenatal depression, a single low dose of esketamine after childbirth decreases major depressive episodes at 42 days post partum by about three quarters. Neuropsychiatric symptoms were more frequent but transient and did not require drug intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT04414943.
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Affiliation(s)
- Shuo Wang
- Department of Anaesthesiology, Peking University First Hospital, Beijing 100034, China
| | - Chun-Mei Deng
- Department of Anaesthesiology, Peking University First Hospital, Beijing 100034, China
| | - Yuan Zeng
- Department of Anaesthesiology, Peking University First Hospital, Beijing 100034, China
| | - Xin-Zhong Chen
- Department of Anaesthesiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Ai-Yuan Li
- Department of Anaesthesiology, Hunan Province Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Shan-Wu Feng
- Department of Anaesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu Province, China
| | - Li-Li Xu
- Department of Anaesthesiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Liang Chen
- Department of Anaesthesiology, Hunan Province Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Hong-Mei Yuan
- Department of Anaesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu Province, China
| | - Han Hu
- Department of Anaesthesiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Tian Yang
- Department of Anaesthesiology, Hunan Province Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Tao Han
- Department of Anaesthesiology, Hunan Province Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Hui-Ying Zhang
- Department of Anaesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu Province, China
| | - Ming Jiang
- Department of Anaesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu Province, China
| | - Xin-Yu Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Hui-Ning Guo
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
- Outcomes Research Consortium, Cleveland, OH, USA
| | - Dong-Xin Wang
- Department of Anaesthesiology, Peking University First Hospital, Beijing 100034, China
- Outcomes Research Consortium, Cleveland, OH, USA
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El-Heis S, Barton SJ, Chang HF, Nield H, Cox V, Galani S, Cutfield W, Chan SY, Godfrey KM. Maternal mood, anxiety and mental health functioning after combined myo-inositol, probiotics, micronutrient supplementation from preconception: Findings from the NiPPeR RCT. Psychiatry Res 2024; 334:115813. [PMID: 38402742 PMCID: PMC11137872 DOI: 10.1016/j.psychres.2024.115813] [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: 05/09/2023] [Revised: 11/24/2023] [Accepted: 02/22/2024] [Indexed: 02/27/2024]
Abstract
Observational studies have reported associations between nutrition during pregnancy and mental wellbeing. As secondary outcomes, the NiPPeR double-blind randomized trial in women planning conception investigated whether a myo-inositol, probiotics and enriched micronutrients formulation (intervention) taken preconception and throughout pregnancy could improve mental wellbeing during pregnancy and post-delivery, compared with a standard micronutrient supplement (control). Mood and anxiety symptoms were ascertained (Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI-state)) at preconception (baseline), 7, 28 and 34 weeks gestation, 3-weeks and 6-months post-delivery. EPDS>=13 was categorised as low mood; STAI-state>=45 as high anxiety. Change in mental health functioning was assessed as difference between preconception baseline and 6-month post-delivery 12-item Short-Form Health Survey (SF-12v2) mental component scores. Adjusting for site, ethnicity and baseline scores, there were no robust differences in EPDS and STAI-state scores between intervention and control groups across pregnancy (n = 630) and post-delivery (n = 532). Compared to controls, intervention group women averaged a 1.21 (95 %CI 0.04,2.39) higher change in SF-12v2 mental component score from preconception to 6-months post-delivery. Taking a myo-inositol, micronutrient and probiotic supplement during preconception/pregnancy had no effect on mood and anxiety, but there was evidence of a modest improvement in mental health functioning from preconception to 6-months post-delivery.
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Affiliation(s)
- Sarah El-Heis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton, Southampton and University Hospital Southampton NHS Foundation Trust, SO16 6YD, United Kingdom.
| | - Sheila J Barton
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton, Southampton and University Hospital Southampton NHS Foundation Trust, SO16 6YD, United Kingdom
| | - Hsin Fang Chang
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, 119228
| | - Heidi Nield
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Vanessa Cox
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Sevasti Galani
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Wayne Cutfield
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
| | - Shiao-Yng Chan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, 119228; Agency for Science, Technology and Research, Singapore Institute for Clinical Sciences, 117609, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton, Southampton and University Hospital Southampton NHS Foundation Trust, SO16 6YD, United Kingdom
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18
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Sirkiä C, Laakkonen E, Nordenswan E, Karlsson L, Korja R, Karlsson H, Kataja EL. Sense of coherence, its components and depressive and anxiety symptoms in expecting women and their partners - A FinnBrain Birth Cohort Study. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 39:100930. [PMID: 38056383 DOI: 10.1016/j.srhc.2023.100930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/22/2023] [Accepted: 11/23/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Expecting mothers with high sense of coherence (SOC) exhibit improved physical, emotional, and childbearing health. However, the dimensions of SOC and the factor structure of the SOC-13 scale during prenatal period is slightly known. Especially the differences in experiencing SOC and its components (comprehensibility, manageability, meaningfulness) among both expecting parents (mothers and fathers) is poorly understood. The association between SOC and mood disorder symptoms (depression and anxiety) during pregnancy is scarcely studied. METHODS The structure of the SOC-13 scale, differences in SOC experiences, and the associations between SOC and depressive and anxiety symptoms were studied in a sample of 2784 pregnant women (mothers) and 1661 men/partners (fathers) belonging to the FinnBrain Birth Cohort Study. Self-reports (SOC-13, EPDS, SCL-90: ANX) from gestational week 24 were used. Confirmatory factor analysis (CFA) and invariance testing was carried out to investigate the factorial structure of SOC-13 among both groups (mothers and fathers). Group comparisons were used to study differences in the level of SOC among mothers vs. fathers, low vs. high depression and anxiety subgroups, and multiparous vs. nulliparous mothers. RESULTS A two-factor model for SOC-13 consisting of comprehensibility-manageability and meaningfulness fitted the data best. Mothers reported higher levels of meaningfulness, whereas fathers reported higher levels of comprehensibility-manageability. SOC was significantly higher among fathers vs. mothers, but mothers with depressive symptoms reported higher SOC than fathers with depressive symptoms. CONCLUSIONS During pregnancy, SOC can be viewed as a two-dimensional (vs. one- or three-dimensional) concept, and mothers and fathers have differences in the components of SOC. Importantly, mothers vs. fathers with depressive symptoms express higher overall SOC indicating that pregnancy may relate to higher than usual SOC especially among women with psychological distress. Understanding how expecting mothers and fathers experience SOC during pregnancy, particularly in relation to depressive symptoms, helps midwives and maternity care providers to focus health promoting support more precisely.
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Affiliation(s)
- Carlos Sirkiä
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland; Department of Psychology, University of Turku, Turku, Finland.
| | - Eero Laakkonen
- Department of Teacher Education, University of Turku, Turku, Finland
| | - Elisabeth Nordenswan
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland; Departments of Psychiatry and Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Riikka Korja
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland; Department of Psychology, University of Turku, Turku, Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland; Departments of Psychiatry and Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Eeva-Leena Kataja
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland; Departments of Psychiatry and Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
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Wisner KL, Avram MJ, George AL, Abramova TV, Yang A, Caritis SN, Costantine MM, Stika CS. Concentrations of Fluoxetine Enantiomers Decline During Pregnancy and Increase After Birth. J Clin Psychopharmacol 2024; 44:100-106. [PMID: 38421920 PMCID: PMC10906734 DOI: 10.1097/jcp.0000000000001821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
RATIONALE Few studies of the effect of the dynamic physiologic changes during pregnancy on plasma concentrations of fluoxetine (FLX) have been published. OBJECTIVES We determined the change in concentration to dose (C/D) ratios of R- and S-FLX and R- and S-norfluoxetine monthly during pregnancy and postpartum, assessed their relationships to cytochrome P450 (CYP) 2D6 and CYP2C9 metabolizer phenotypes, and evaluated the course of their depressive and anxiety symptoms. METHODS In this observational study, 10 FLX-treated pregnant individuals provided blood samples at steady state every 4 weeks during pregnancy and once postpartum for measurement of plasma FLX and norfluoxetine enantiomer concentrations. Participants were genotyped for variants in CYP2C9 and CYP2D6 using commercial assays with Taqman probes. At each assessment, depressive and anxiety symptoms were quantified. RESULTS The C/D ratios of all FLX and norfluoxetine enantiomers, and the active moiety, decreased steadily through pregnancy and rose after birth. In the final trimester, the mean C/D ratio of the active moiety was 24.9% lower compared with the mean nonpregnant, 12-week postpartum C/D ratio. One individual with CYP2D6 ultrarapid metabolizer status was prescribed the highest FLX dose among participants. In these treated individuals, the mean depressive and anxiety symptoms remained in the mild range across the perinatal period. CONCLUSIONS These data do not support a recommendation for routine plasma concentration monitoring or CYP2D6 pharmacogenetic testing for pregnant people treated with FLX; however, monitoring for symptom relapse is recommended because of declining plasma drug concentrations.
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Affiliation(s)
- Katherine L. Wisner
- Developing Brain Institute, Children’s National Hospital, 111 Michigan Ave. NW, Washington, DC 20001. This work was conducted while Dr. Wisner was at Northwestern University Feinberg School of Medicine
- Department of Obstetrics and Gynecology, Northwestern University’s Feinberg School of Medicine, 250 E Superior Street, Suite 03-2303; Chicago, IL 60611, USA
| | - Michael J. Avram
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Chicago, IL, 60611 USA
| | - Alfred L. George
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, 320 East Superior Street, Chicago, IL 60611 USA
| | - Tatiana V. Abramova
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, 320 East Superior Street, Chicago, IL 60611 USA
| | - Amy Yang
- AY Analytics, 20 Melrose St, Westmont, IL 60559 USA (contractual statistical service to Northwestern University Feinberg School of Medicine)
| | - Steve N. Caritis
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Magee Womens Hospital, 300 Halket St, Pittsburgh, PA 15213 USA
| | - Maged M. Costantine
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, 410 W 10 Ave, Columbus, OH 43210 USA
| | - Catherine S. Stika
- Department of Obstetrics and Gynecology, Northwestern University’s Feinberg School of Medicine, 250 E Superior Street, Suite 03-2303; Chicago, IL 60611, USA
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20
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Hu L, Mei H, Cai X, Song L, Xu Q, Gao W, Zhang D, Zhou J, Sun C, Li Y, Xiang F, Wang Y, Zhou A, Xiao H. Prenatal exposure to poly- and perfluoroalkyl substances and postpartum depression in women with twin pregnancies. Int J Hyg Environ Health 2024; 256:114324. [PMID: 38271819 DOI: 10.1016/j.ijheh.2024.114324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/18/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Women with multiple pregnancies are vulnerable to experience postpartum depression (PPD). Emerging evidence indicates an association between poly- and perfluoroalkyl substances (PFAS) exposure and PPD in women delivering singletons. The health risks of PFAS may also be present in women delivering twins. OBJECTIVE To estimate the impacts of prenatal PFAS exposure on the risk of PPD in women with twin pregnancies. METHODS Our study included 150 mothers who gave birth to twins and were enrolled in the Wuhan Twin Birth Cohort. The concentrations of maternal plasma PFAS were measured in each trimester and averaged. Eight individual PFAS were included in analyses. We used Edinburgh Postnatal Depression Scale to evaluate maternal depression at early pregnancy and 1 and 6 months after childbirth. The outcome was dichotomized using a cutoff value of ≥10 for main analyses. Associations were examined using multiple informant models and modified Poisson regressions. PFAS mixture effects were estimated using quantile g-computation. RESULTS Using quantile g-computation models, a quartile increase in the PFAS mixture during the first, second, third, and average pregnancy was significantly associated with a relative risk (RR) of 1.73 (95% CI: 1.42, 2.12), 1.54 (95% CI: 1.27, 1.84), 1.75 (95% CI: 1.49, 2.08), and 1.63 (95% CI: 1.35, 1.97) for PPD at 6 months after childbirth, respectively. The results of the single-PFAS models also indicated significant positive associations between individual PFAS and PPD at both 1 and 6 months. CONCLUSIONS The first study of women with twin pregnancies suggests that prenatal exposure to PFAS increases PPD risk up to 6 months postpartum. Twin pregnant women should receive long-term follow-up after delivery and extensive social support.
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Affiliation(s)
- Liqin Hu
- Institute of Maternal and Child Health, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Hong Mei
- Institute of Maternal and Child Health, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Xiaonan Cai
- Institute of Maternal and Child Health, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Lulu Song
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan, Hubei, 430030, PR China; Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Qiao Xu
- Department of Obstetrics, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Wenqi Gao
- Institute of Maternal and Child Health, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Dan Zhang
- Woman Healthcare Department for Community, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Jieqiong Zhou
- Department of Obstetrics, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Chen Sun
- Maternal Health Care Department, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yi Li
- Department of Obstetrics, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Feiyan Xiang
- Institute of Maternal and Child Health, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Youjie Wang
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan, Hubei, 430030, PR China; Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Aifen Zhou
- Institute of Maternal and Child Health, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
| | - Han Xiao
- Institute of Maternal and Child Health, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
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21
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Woods A, Ballard E, Kumar S, Mackle T, Callaway L, Kothari A, De Jersey S, Bennett E, Foxcroft K, Willis M, Amoako A, Lehner C. The impact of the COVID-19 pandemic on antenatal care provision and associated mental health, obstetric and neonatal outcomes. J Perinat Med 2024; 52:222-229. [PMID: 37883210 DOI: 10.1515/jpm-2023-0196] [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: 05/09/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVES The COVID-19 pandemic imposed many challenges on pregnant women, including rapid changes to antenatal care aimed at reducing the societal spread of the virus. This study aimed to assess how the pandemic affected perinatal mental health and other pregnancy and neonatal outcomes in a tertiary unit in Queensland, Australia. METHODS This was a retrospective cohort study of pregnant women booked for care between March 2019 - June 2019 and March 2020 - June 2020. A total of 1984 women were included with no confirmed cases of COVID-19. The primary outcome of this study was adverse maternal mental health defined as an Edinburgh Postnatal Depression Scale score of ≥13 or an affirmative response to 'EPDS Question 10'. Secondary outcomes were preterm birth <37 weeks and <32 weeks, mode of birth, low birth weight, malpresentation in labour, hypertensive disease, anaemia, iron/vitamin B12 deficiency, stillbirth and a composite of neonatal morbidity and mortality. RESULTS There were no differences in the primary perinatal mental health outcomes. The rates of composite adverse neonatal outcomes (27 vs. 34 %, p<0.001) during the pandemic were higher; however, there was no difference in perinatal mortality (p=1.0), preterm birth (p=0.44) or mode of delivery (p=0.38). CONCLUSIONS Although there were no adverse consequences on maternal mental health during the pandemic, there was a concerning increase in neonatal morbidity potentially due to the altered model of maternity care implemented in the early COVID-19 pandemic.
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Affiliation(s)
- Anousha Woods
- The Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Emma Ballard
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Sailesh Kumar
- Mater Mothers Hospital, The Royal Brisbane and Women's Hospital, The University of Queensland, Brisbane, Australia
| | | | - Leonie Callaway
- The Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Susan De Jersey
- The Royal Brisbane and Women's Hospital, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
| | | | - Katie Foxcroft
- The Royal Brisbane and Women's Hospital, The University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - Meg Willis
- The Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Akwasi Amoako
- The Royal Brisbane and Women's Hospital, Brisbane, Australia
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22
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Fairbrother N, Stagg B, Scoten O, Keeney C, Cargnelli C. Perinatal anxiety disorders screening study: a study protocol. BMC Psychiatry 2024; 24:162. [PMID: 38395837 PMCID: PMC10893673 DOI: 10.1186/s12888-024-05575-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The anxiety and their related disorders (AD) are the most common of all mental health conditions, and affect approximately 20% of pregnant and postpartum people. They are associated with significant distress and life interference for sufferers, as well as negative consequences for fetal and infant development. At present, little if any routine screening for prenatal AD is being conducted and data regarding the most effective tools to screen for these disorders is lacking. The majority of screening studies suffer from methodological difficulties which undermine the confidence needed to recommend measures for population distribution. The primary purpose of this research is to identify the most accurate self-report tool(s) to screen for perinatal AD. METHODS A large, prospective cohort of pregnant people (N = 1,000) is being recruited proportionally across health service delivery regions in British Columbia (BC). The screening accuracy of a broad range of perinatal AD self-report measures are being assessed using gold standard methodology. Consenting individuals are administered online questionnaires followed by a semi-structured diagnostic interview between 16- and 36-weeks' gestation, and again between 6 and 20 weeks postpartum. Questionnaires include all screening measures, measures of sleep and unpaid family work, and questions pertaining to demographic and reproductive history, COVID-19, gender role burden, and mental health treatment utilization. Interviews assess all current anxiety disorders, as well as obsessive-compulsive disorder, and posttraumatic stress disorder. DISCUSSION This research is in response to an urgent demand for accurate perinatal AD screening tools based on high quality evidence. AD among perinatal people often go unidentified and untreated, resulting in continued suffering and life impairment. Findings from this research will inform healthcare providers, policymakers, and scientists, about the most effective approach to screening for anxiety and related disorders in pregnancy in the postpartum period.
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Affiliation(s)
- Nichole Fairbrother
- Department of Family Practice, University of British Columbia, Vancouver, Canada.
| | - Bryn Stagg
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Olivia Scoten
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Cora Keeney
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Claudia Cargnelli
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
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23
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Sampson M, Yu M, Mauldin R, Gonzalez L, Mayorga AN. Home Visits for Postpartum Depression Intervention among Low-Income Latinas: Results from the PST4PPD Project. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:141-155. [PMID: 38445907 DOI: 10.1080/19371918.2024.2319862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Research shows that U.S. Latinas are at risk for high rates of postpartum depression (PPD) but have low rates of treatment compared to non-Hispanic White mothers. This study examined the feasibility of a multi-site home-visiting intervention (PST4PPD) conducted by bilingual community health workers (CHW) among low-income Latina mothers. A one-group, pre/posttest design and paired sample's t-test were used to measure changes in depressive symptoms and self-efficacy for participants (n = 76) across five sites. The Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9) were used to assess depression; the New General Self-Efficacy Scale and the Maternal Efficacy Questionnaire measured general self-efficacy and parenting self-efficacy. Depression scores decreased significantly from pretest to posttest. Participants' general self-efficacy, maternal self-efficacy, and PPD knowledge increased. With a 76% completion rate, demonstrable improvements were seen in participants' depression and self-efficacy. Implications for addressing modifiable factors such as self-efficacy and stress management are discussed.
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Affiliation(s)
- McClain Sampson
- Graduate College of Social Work, University of Houston, Houston, USA
| | - Miao Yu
- Graduate College of Social Work, University of Houston, Houston, USA
| | - Rebecca Mauldin
- School of Social Work, The University of Texas at Arlington, Arlington, USA
| | | | - Angie N Mayorga
- Clinical Psychology Department, University of Houston, Houston, USA
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24
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Ait Belkacem N, Gorgui J, Tchuente V, Aubin D, Lippé S, Bérard A. Maternal Mental Health in Pregnancy and Its Impact on Children's Cognitive Development at 18 Months, during the COVID-19 Pandemic (CONCEPTION Study). J Clin Med 2024; 13:1055. [PMID: 38398369 PMCID: PMC10889100 DOI: 10.3390/jcm13041055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has significantly affected the mental health of pregnant persons. OBJECTIVE We aimed to evaluate the impact of maternal mental health and antidepressant use on children's cognitive development. METHODS We followed a cohort of children born during the COVID-19 pandemic. Maternal mental health was self-reported during pregnancy (Edinburgh Postnatal Depression Scale, General Anxiety Disorder-7, stress levels, and antidepressant use). The child's cognitive development was measured using the third edition of the Ages & Stages Questionnaires® (ASQ-3) at 18 months. Multivariate multinomial logistic regression models were built to assess the association between in utero exposure to maternal mental health and ASQ-3 domains: communication, gross motor, fine motor, problem-solving, and personal-social. RESULTS Overall, 472 children were included in our analyses. After adjusting for potential confounders, a need for further assessment in communication (adjusted odds ratio (aOR) 12.2, 95% confidence interval (CI) (1.60;92.4)), and for improvement in gross motricity (aOR 6.33, 95%CI (2.06;19.4)) were associated with in utero anxiety. The need for improvement in fine motricity (aOR 4.11, 95%CI (1.00; 16.90)) was associated with antidepressant exposure. In utero depression was associated with a decrease in the need for improvement in problem solving (aOR 0.48, 95%CI (0.24; 0.98)). CONCLUSIONS During the COVID-19 pandemic, maternal mental health appears to be associated with some aspects of children's cognitive development.
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Affiliation(s)
- Narimene Ait Belkacem
- Faculty of Pharmacy, University of Montreal, Montreal, QC H3T 1J4, Canada; (N.A.B.); (J.G.)
- Research Center, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada; (V.T.); (D.A.); (S.L.)
| | - Jessica Gorgui
- Faculty of Pharmacy, University of Montreal, Montreal, QC H3T 1J4, Canada; (N.A.B.); (J.G.)
- Research Center, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada; (V.T.); (D.A.); (S.L.)
| | - Vanina Tchuente
- Research Center, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada; (V.T.); (D.A.); (S.L.)
| | - Delphine Aubin
- Research Center, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada; (V.T.); (D.A.); (S.L.)
- Department of Psychology, University of Montreal, Montreal, QC H2V 2S9, Canada
| | - Sarah Lippé
- Research Center, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada; (V.T.); (D.A.); (S.L.)
- Department of Psychology, University of Montreal, Montreal, QC H2V 2S9, Canada
| | - Anick Bérard
- Faculty of Pharmacy, University of Montreal, Montreal, QC H3T 1J4, Canada; (N.A.B.); (J.G.)
- Research Center, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada; (V.T.); (D.A.); (S.L.)
- Faculty of Medicine, Université Claude Bernard, Lyon 1, 69003 Lyon, France
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Caljé E, Oyston C, Wang Z, Bloomfield F, Marriott J, Dixon L, Groom K. The fatigue after infusion or transfusion pilot trial and feasibility study: A three-armed randomized pilot trial of intravenous iron and blood transfusion for the treatment of postpartum anemia. Transfusion 2024; 64:301-314. [PMID: 38149691 DOI: 10.1111/trf.17621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Evidence for the management of moderate-to-severe postpartum anemia is limited. A randomized trial is needed; recruitment may be challenging. STUDY DESIGN AND METHODS Randomized pilot trial with feasibility surveys. INCLUSION hemoglobin 65-79 g/L, ≤7 days of birth, hemodynamically stable. EXCLUSION ongoing heavy bleeding; already received, or contraindication to intravenous (IV)-iron or red blood cell transfusion (RBC-T). Intervention/control: IV-iron; RBC-T; or IV-iron and RBC-T. PRIMARY OUTCOME number of recruits; proportion of those approached; proportion considered potentially eligible. SECONDARY OUTCOMES fatigue, depression, baby-feeding, and hemoglobin at 1, 6 and 12 weeks; ferritin at 6 and 12 weeks. Surveys explored attitudes to trial participation. RESULTS Over 16 weeks and three sites, 26/34 (76%) women approached consented to trial participation, including eight (31%) Māori women. Of those potentially eligible, 26/167 (15.6%) consented to participate. Key participation enablers were altruism and study relevance. For clinicians and stakeholders the availability of research assistance was the key barrier/enabler. Between-group rates of fatigue and depression were similar. Although underpowered to address secondary outcomes, IV-iron and RBC-T compared with RBC-T were associated with higher hemoglobin concentrations at 6 (mean difference [MD] 11.7 g/L, 95% confidence interval [CI] 2.7-20.7) and 12 (MD 12.8 g/L, 95% CI 1.5-24.2) weeks, and higher ferritin concentrations at 6 weeks (MD 136.8 mcg/L, 95% CI 76.6-196.9). DISCUSSION Willingness to participate supports feasibility for a future trial assessing the effectiveness of IV-iron and RBC-T for postpartum anemia. Dedicated research assistance will be critical to the success of an appropriately powered trial including women-centered outcomes.
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Affiliation(s)
- Esther Caljé
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Charlotte Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
- Middlemore Hospital, Auckland, New Zealand
| | - Zeke Wang
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Frank Bloomfield
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Joy Marriott
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Lesley Dixon
- New Zealand College of Midwives, Christchurch, New Zealand
| | - Katie Groom
- Liggins Institute, The University of Auckland, Auckland, New Zealand
- National Women's Health, Auckland City Hospital, Auckland, New Zealand
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Tesson S, Swinsburg D, Nielson-Jones C, Costa DSJ, Winlaw DS, Badawi N, Sholler GF, Butow PN, Kasparian NA. Mother-Infant Dyadic Synchrony and Interaction Patterns After Infant Cardiac Surgery. J Pediatr Psychol 2024; 49:13-26. [PMID: 37873696 DOI: 10.1093/jpepsy/jsad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/19/2023] [Accepted: 09/19/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVE Parents and their infants with complex congenital heart disease (CHD) face relational challenges, including marked distress, early separations, and infant hospitalizations and medical procedures, yet the prevalence of parent-infant interaction difficulties remains unclear. Using a standardized observational paradigm, this study investigated mother-infant dyadic synchrony, interactional patterns, and associated predictors in mother-infant pairs affected by CHD, compared with typically-developing pairs. METHODS In this prospective, longitudinal cohort study, mothers and their infants requiring cardiac surgery before age 6-months (n=110 pairs) and an age- and sex-matched Australian community sample (n=85 pairs) participated in a filmed, free-play interaction at 6.9±1.0 months. Mother-infant dyadic synchrony, maternal and infant interactional patterns, and relational risk were assessed using the Child-Adult Relationship Experimental (CARE) Index. Maternal and infant predictors were assessed at 32 weeks gestation, 3- and 6-months postpartum. RESULTS Most mother-infant interactions were classified as "high risk" or "inept" (cardiac: 94%, control: 81%; p=.007). Dyadic synchrony (p<.001), maternal sensitivity (p=.001), and infant cooperativeness (p=.001) were lower for cardiac than control pairs. Higher maternal traumatic stress at 6-months postpartum predicted lower dyadic synchrony for mother-infant pairs affected by CHD (B=-.04, p=.03). Dyadic synchrony was higher among older infants in the total (B=.40, p=.003) but not cardiac sample (B=.24, p=.06). CONCLUSIONS Relational difficulties were almost universal among mother-infant pairs affected by CHD and were also high in the Australian community sample. Widespread education initiatives are recommended to increase awareness of heightened mother-infant relational risk in congenital heart care and well-child settings, alongside relationally-focused prevention and early intervention programs.
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Affiliation(s)
- Stephanie Tesson
- Heart Centre for Children, The Sydney Children's Hospitals Network, Australia
- School of Psychology, The University of Sydney, Australia
- Faculty of Medicine and Health, The University of New South Wales, Australia
| | - Dianne Swinsburg
- Heart Centre for Children, The Sydney Children's Hospitals Network, Australia
- Faculty of Medicine and Health, The University of New South Wales, Australia
| | - Claudia Nielson-Jones
- Heart Centre for Children, The Sydney Children's Hospitals Network, Australia
- Faculty of Medicine and Health, The University of New South Wales, Australia
| | - Daniel S J Costa
- School of Psychology, The University of Sydney, Australia
- Pain Management Research Institute, Royal North Shore Hospital, Australia
| | - David S Winlaw
- Heart Institute, Cincinnati Children's Hospital Medical Center, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Nadia Badawi
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Australia
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Australia
| | - Gary F Sholler
- Heart Centre for Children, The Sydney Children's Hospitals Network, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Australia
| | - Phyllis N Butow
- School of Psychology, The University of Sydney, Australia
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Australia
| | - Nadine A Kasparian
- Heart Institute, Cincinnati Children's Hospital Medical Center, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, USA
- Heart and Mind Wellbeing Center, Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, USA
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Dachew BA, Adane AA, Alati R. Maternal Pregnancy and Pre-Pregnancy Weight and Behavioural Outcomes in Children. Behav Sci (Basel) 2024; 14:49. [PMID: 38247701 PMCID: PMC10812996 DOI: 10.3390/bs14010049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/21/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
Reported associations of pre-pregnancy weight and/or gestational weight gain with offspring behavioural outcomes are inconsistent. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), this study aimed to examine these associations at five developmental stages between the ages of 3 and 16. Over 6800 mother-offspring pairs at age 3 and 3925 pairs at age 16 were included. Pre-pregnancy underweight was associated with a 22% increased risk of total behavioural difficulties (OR = 1.22, 95% CI 1.02-1.45). In separate analyses using the SDQ subscales, pre-pregnancy underweight was linked to a 37% (OR = 1.37, 95% CI 1.14-1.65) and 33% (OR = 1.33, 95% CI 1.01-1.76) increased risk of emotional symptoms and prosocial behaviour problems over time, respectively. While pre-pregnancy overweight was associated with an 11% (OR = 1.11, 95% CI 1.03-1.20) and 18% (OR = 1.18, 95% CI 1.03-1.36) increased risk of conduct and peer relationship problems, respectively, pregnancy obesity was associated with a 43% increased risk of emotional problems (OR = 1.43, 95% CI 1.16-1.77). We found no evidence of associations between gestational weight gain and child behaviour except for a reduced risk in prosocial behaviour problems (OR = 0.82, 95% CI 0.70-0.96). Our findings provide insights into the link between preconception BMI and child behaviour, underscoring the necessity for further research to validate these associations and elucidate underlying mechanisms.
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Affiliation(s)
- Berihun A. Dachew
- School of Population Health, Curtin University, Bentley, WA 6102, Australia;
- enAble Institute, Curtin University, Bentley, WA 6102, Australia
| | - Akilew A. Adane
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA 6150, Australia;
| | - Rosa Alati
- School of Population Health, Curtin University, Bentley, WA 6102, Australia;
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD 4068, Australia
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Yang R, Lin Z, Cai Y, Chen N, Zhou Y, Zhang J, Hong G. Assessing the risk of prenatal depressive symptoms in Chinese women: an integrated evaluation of serum metabolome, multivitamin supplement intake, and clinical blood indicators. Front Psychiatry 2024; 14:1234461. [PMID: 38274432 PMCID: PMC10808622 DOI: 10.3389/fpsyt.2023.1234461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Background Prenatal depressive symptoms (PDS) is a serious public health problem. This study aimed to develop an integrated panel and nomogram to assess at-risk populations by examining the association of PDS with the serum metabolome, multivitamin supplement intake, and clinical blood indicators. Methods This study comprised 221 pregnant women, categorized into PDS and non-PDS groups based on the Edinburgh postnatal depression scale. The participants were divided into training and test sets according to their enrollment time. We conducted logistic regression analysis to identify risk factors, and employed liquid chromatography/high resolution mass spectrometry-based serum metabolome analysis to identify metabolic biomarkers. Multiple factor analysis was used to combine risk factors, clinical blood indicators and key metabolites, and then a nomogram was developed to estimate the probability of PDS. Results We identified 36 important differential serum metabolites as PDS biomarkers, mainly involved in amino acid metabolism and lipid metabolism. Multivitamin intake works as a protective factor for PDS. The nomogram model, including multivitamin intake, HDL-C and three key metabolites (histidine, estrone and valylasparagine), exhibited an AUC of 0.855 in the training set and 0.774 in the test set, and the calibration curves showed good agreement, indicating that the model had good stability. Conclusion Our approach integrates multiple models to identify metabolic biomarkers for PDS, ensuring their robustness. Furthermore, the inclusion of dietary factors and clinical blood indicators allows for a comprehensive characterization of each participant. The analysis culminated in an intuitive nomogram based on multimodal data, displaying potential performance in initial PDS risk assessment.
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Affiliation(s)
- Rongrong Yang
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen, China
| | - Zhenguo Lin
- Department of Clinical Medicine, Xiamen Medical College, Xiamen, China
| | - Yanhua Cai
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen, China
| | - Nan Chen
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen, China
| | - Ying Zhou
- Department of Obstetrics and Gynecology, Clinical Medical Research Center for Obstetrics and Gynecology Diseases, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Jie Zhang
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen, China
| | - Guolin Hong
- Department of Laboratory Medicine, Xiamen Key Laboratory of Genetic Testing, The First Affiliated Hospital of Xiamen University, School of Public Health, Xiamen University, Xiamen, China
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Zhu B, Hou Y, Yu X, Jiang M, Lu M, Shang M, Zhen H, Gu Y, Li H, Tao F. A hybrid effectiveness-implementation trial of application-based tiered care (Mom's Good Mood) in treating perinatal anxiety within a primary health care system in China. BMJ Glob Health 2024; 9:e013604. [PMID: 38195154 PMCID: PMC10806923 DOI: 10.1136/bmjgh-2023-013604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/25/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION Perinatal anxiety (PNA) is a major public health concern. METHODS A hybrid effectiveness-implementation trial was conducted in two antenatal clinics in Hefei, China, to assess the effectiveness and cost-effectiveness of application-based tiered care (Mom's Good Mood, MGM) in treating PNA and to understand how well it fits into routine practices. Pregnant women who scored at least 5 points on the 7-Item Generalised Anxiety Disorder Scale (GAD-7) scale were successively assigned to the control group or the intervention group, which were given the usual care and MGM on usual care, respectively. At 6 months post partum, anxiety, depression and life satisfaction were assessed. Intention-to-treat analysis and the Reach, Effectiveness, Adoption, Implementation and Maintenance framework were adopted. RESULTS A total of 214 women were assigned to the control group and 341 to the intervention group. The mean changes in GAD-7 scores (Least-squares means, LSM, -1.42, 95% CI -2.18 to -0.66) and the risk of anxiety (adjusted odds ratio, aOR 0.30, 95% CI 0.18 to 0.51) were decreased, and the anxiety remission rate (aOR 2.72, 95% CI 1.69 to 4.40) were improved in the intervention group. Similar findings were observed regarding the change in Edinburgh Postnatal Depression Scale scores (LS -1.92, 95% CI -2.85 to -0.99), depression remission rate (aOR 2.24, 95% CI 1.39 to 3.63) and the risk of depression (aOR 0.57, 95% CI 0.33 to 0.98). MGM only costs ¥1.88 (US$0.27) per pregnant woman to boost the postpartum anxiety remission rate by 1% and was revealed to have a high reach rate of 78.3%, an adoption rate of 51.3%-80.8%. CONCLUSION MGM is a cost-effective and accessible tool in coping with PNA. TRIAL REGISTRATION NUMBER ChiCTR2100053419.
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Affiliation(s)
- Beibei Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, Anhui, China
- Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Yanyan Hou
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, Anhui, China
- Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Xiayan Yu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, Anhui, China
- Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Minmin Jiang
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, Anhui, China
- Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
- Department of Occupational Health and Environmental Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Mengjuan Lu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, Anhui, China
- Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Mengqing Shang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, Anhui, China
- Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Hualong Zhen
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, Anhui, China
- Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
- Department of Occupational Health and Environmental Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Yue Gu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, Anhui, China
- Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Haiyan Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, Anhui, China
- Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, Anhui, China
- Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
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Bluett-Duncan M, Pickles A, Chandra PS, Hill J, Kishore MT, Satyanarayana V, Sharp H. Experience and Reporting of Postnatal Depression Across Cultures: A Comparison Using Anchoring Vignettes of Mothers in the United Kingdom and India. Am J Epidemiol 2024; 193:214-226. [PMID: 37667811 PMCID: PMC10773478 DOI: 10.1093/aje/kwad182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/06/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023] Open
Abstract
Postnatal mental health is often assessed using self-assessment questionnaires in epidemiologic research. Differences in response style, influenced by language, culture, and experience, may mean that the same response may not have the same meaning in different settings. These differences need to be identified and accounted for in cross-cultural comparisons. Here we describe the development and application of anchoring vignettes to investigate the cross-cultural functioning of the Edinburgh Postnatal Depression Scale (EPDS) in urban community samples in India (n = 549) and the United Kingdom (n = 828), alongside a UK calibration sample (n = 226). Participants completed the EPDS and anchoring vignettes when their children were 12-24 months old. In an unadjusted item-response theory model, UK mothers reported higher depressive symptoms than Indian mothers (d = 0.48, 95% confidence interval: 0.358, 0.599). Following adjustment for differences in response style, these positions were reversed (d = -0.25, 95% confidence interval: -0.391, -0.103). Response styles vary between India and the United Kingdom, indicating a need to take these differences into account when making cross-cultural comparisons. Anchoring vignettes offer a valid and feasible method for global data harmonization.
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Affiliation(s)
- Matthew Bluett-Duncan
- Correspondence to Dr. Matthew Bluett-Duncan, Division of Neuroscience, University of Manchester, Manchester M13 9NT, United Kingdom (e-mail: )
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31
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Caljé E, Groom KM, Dixon L, Marriott J, Foon R, Oyston C, Bloomfield FH, Jordan V. Intravenous iron versus blood transfusion for postpartum anemia: a systematic review and meta-analysis. Syst Rev 2024; 13:9. [PMID: 38169415 PMCID: PMC10759729 DOI: 10.1186/s13643-023-02400-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 11/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Intravenous iron (IV-iron) is used as an alternative to, or alongside, red blood cell transfusion (RBC-T) to treat more severe postpartum anemia (PPA), although optimal treatment options remain unclear. No previous systematic reviews have examined IV-iron and RBC-T, including patient-reported outcomes and hematological responses. METHODS A systematic review and meta-analysis of randomized trials comparing IV-iron and RBC-T with each other, oral iron, no treatment, and placebo for the treatment of PPA. Key inclusion criteria were PPA (hemoglobin < 12 g/dL) and IV-iron or RBC-T as interventions. Key exclusion criteria were antenatal IV-iron or RBC-T. Fatigue was the primary outcome. Secondary outcomes included hemoglobin and ferritin concentrations, and adverse events. From 27th August 2020 to 26th September 2022, databases, registries, and hand searches identified studies. A fixed-effect meta-analysis was undertaken using RevMan (5.4) software. The quality of the studies and the evidence was assessed using the Cochrane Risk of Bias table, and Grading of Recommendations, Assessment, Development, and Evaluation. This review is registered with the Prospective Register of Systematic Reviews (CRD42020201115). RESULTS Twenty studies and 4196 participants were included: 1834 assigned IV-iron, 1771 assigned oral iron, 330 assigned RBC-T, and 261 assigned non-intervention. Six studies reported the primary outcome of fatigue (1251 participants). Only studies of IV-iron vs. oral iron (15 studies) were available for meta-analysis. Of these, three reported on fatigue using different scales; two were available for meta-analysis. There was a significant reduction in fatigue with IV-iron compared to oral iron (standardized mean difference - 0.40, 95% confidence interval (CI) - 0.62, - 0.18, I2 = 0%). The direction of effect also favored IV-iron for hemoglobin (mean difference (MD) 0.54 g/dL, 95% confidence interval (CI) 0.47, 0.61, I2 = 91%), ferritin, (MD 58.07 mcg/L, 95% CI 55.74, 60.41, I2 = 99%), and total adverse events (risk-ratio 0.63, 95% CI 0.52, 0.77, I2 = 84%). The overall quality of the evidence was low-moderate. DISCUSSION For all outcomes, the evidence for RBC-T, compared to IV-iron, non-intervention, or dose effects of RBC-T is very limited. Further research is needed to determine whether RBC-T or IV-iron for the treatment of PPA is superior for fatigue and hematological outcomes.
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Affiliation(s)
- E Caljé
- Liggins Institute, University of Auckland, Auckland, New Zealand.
| | - K M Groom
- Liggins Institute, University of Auckland, Auckland, New Zealand
- National Women's Health, Auckland City Hospital, Auckland, New Zealand
| | - L Dixon
- New Zealand College of Midwives, Christchurch, New Zealand
| | - J Marriott
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - R Foon
- Waikato Hospital, Hamilton, New Zealand
| | - C Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
- Middlemore Hospital, Auckland, New Zealand
| | - F H Bloomfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - V Jordan
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
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Christian C, Zerwas SC, Levinson CA. The Unique and Moderating Role of Social and Self-Evaluative Factors on Perinatal Eating Disorder and Depression Symptoms. Behav Ther 2024; 55:122-135. [PMID: 38216226 PMCID: PMC10787154 DOI: 10.1016/j.beth.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 04/25/2023] [Accepted: 05/18/2023] [Indexed: 01/14/2024]
Abstract
Pregnancy and postpartum represent a critical transition period for changes in eating disorder (ED) symptoms and depression. Past research has established a relationship between ED and depressive symptoms during pregnancy. However, changes in depression and ED symptom across stages of pregnancy and postpartum, and factors that influence this relationship, remain understudied. Social factors and self-evaluative factors may be important given rapidly changing social pressures and expectations during this transitional time. The current study (N = 454 pregnant women) examined (1) differences in ED and depressive symptoms across pregnancy and postpartum and (2) whether social factors (social appearance anxiety; social support) and self-evaluative factors (maladaptive perfectionism; self-compassion) moderate the relationship between depression and ED symptoms cross-sectionally and prospectively. Study aims, hypotheses, and data analysis were preregistered on the Open Science Foundation (osf.io). This study did not identify differences in ED or depression symptoms across women at different stages of pregnancy; however, depression symptoms significantly improved within individuals from pregnancy to postpartum. ED symptoms and all social and self-evaluative factors were uniquely associated with depression during pregnancy. ED symptoms, maladaptive perfectionism, social appearance anxiety, and self-compassion during pregnancy significantly predicted postpartum depression, when accounting for prenatal depression. During pregnancy, but not postpartum, when social support and self-compassion were low, and when maladaptive perfectionism was high, there was a stronger relationship between ED and depression symptoms. ED symptoms and social and self-evaluative factors could be targeted in routine medical care and stepped-care interventions to improve maternal mental healthcare and prevent postpartum depression.
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Galbally M, Watson SJ, Boyce P, Howard L, Herrman H. Perinatal depression: The use of the Edinburgh Postnatal Depression Scale to derive clinical subtypes. Aust N Z J Psychiatry 2024; 58:37-48. [PMID: 37649275 DOI: 10.1177/00048674231193640] [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] [Indexed: 09/01/2023]
Abstract
BACKGROUND Predicting the course and complications of perinatal depression through the identification of clinical subtypes has been previously undertaken using the Edinburgh Postnatal Depression Scale and has the potential to improve the precision of care and improve outcomes for women and their children. METHODS Edinburgh Postnatal Depression Scale scores were collected twice in pregnancy and twice in the postpartum in a sample of 360 women who met diagnostic criteria for perinatal depression using the Structured Clinical Interview for DSM disorder. These data were used to compare with previous, though conflicting, evidence from cross-sectional studies and extend this by undertaking longitudinal measurement invariance modelling to test the structural validity across the perinatal period. Latent profile and transition modelling was used to identify distinct subtypes of women and assess the utility of these subtypes and transition profiles to predict clinically meaningful outcomes. RESULTS Although our data supported one of the previously reported three-factor Edinburgh Postnatal Depression Scale structures used to compute subfactor totals for depressed mood, anxiety and anhedonia at both early pregnancy and 6 months postpartum, there was little value in using these Edinburgh Postnatal Depression Scale subfactor scores to identify subtypes predictive of clinically meaningful postpartum symptom subtypes, or of general health, pregnancy and neonatal outcomes. CONCLUSION Our study does not support the use of the Edinburgh Postnatal Depression Scale to distinguish perinatal depressive subtypes for the purposes of predicting course and complications associated with perinatal depression. However, the results give guidance on alternative ways to study the value of personalised management in improved outcomes for women living with or at risk for perinatal depression.
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Affiliation(s)
- Megan Galbally
- School of Clinical Sciences, Department of Psychiatry, Monash University, Clayton, VIC, Australia
- Health Futures Institute, Murdoch University, Murdoch, WA, Australia
| | - Stuart J Watson
- School of Clinical Sciences, Department of Psychiatry, Monash University, Clayton, VIC, Australia
- Health Futures Institute, Murdoch University, Murdoch, WA, Australia
| | - Philip Boyce
- Specialty of Psychiatry, Faculty of Medicine and Health and The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Louise Howard
- Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Helen Herrman
- Orygen Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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Karim S, Liu J, Wilcox S, Cai B, Merchant AT. Association Between Physical Activity During Pregnancy and Perinatal Depressive Symptoms in Pregnant Individuals With Overweight and Obesity. Womens Health Issues 2024; 34:72-79. [PMID: 37940507 PMCID: PMC10843526 DOI: 10.1016/j.whi.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 09/01/2023] [Accepted: 09/21/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Current research on the association between physical activity and perinatal depression is inconclusive. This study examined the association between objectively measured physical activity during pregnancy and perinatal depressive symptoms among individuals with overweight and obesity. METHODS Data came from the Health in Pregnancy and Postpartum study (N = 205). Physical activity was measured using the SenseWear Armband at 16 weeks' or fewer and 32 weeks' gestation and categorized into 1) never meeting 2018 physical activity guidelines, 2) meeting the guidelines at one time point, or 3) meeting the guidelines at both time points. Antenatal depressive symptoms were assessed at 32 weeks' gestation, and postpartum depressive symptoms were assessed at 6 and 12 months postpartum using the Edinburgh Postnatal Depression Scale. A score of 10 or higher was defined as probable at least minor depression (hereafter, probable depression). RESULTS Nearly one-half of the participants (45.4%) met physical activity guidelines both in early and late pregnancy. Pregnant individuals who met physical activity guidelines at one (adjusted odds ratio, 0.07; 95% confidence interval, 0.01-0.76) or both time points (adjusted odds ratio, 0.08; 95% confidence interval, 0.01-0.69) during pregnancy had lower odds of probable depression at 6 months postpartum than individuals who never met physical activity guidelines during pregnancy. No significant associations were found between prenatal physical activity and probable antenatal or postpartum depression at 12 months. CONCLUSIONS Antenatal physical activity was associated with lower odds of probable depression at 6 months after childbirth. Physicians should use evidence-based strategies to encourage pregnant people, especially those who are at risk for postpartum depression, to meet physical activity guidelines.
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Affiliation(s)
- Sabrina Karim
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Institute for Families in Society, College of Social Work, University of South Carolina, Columbia, South Carolina
| | - Jihong Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
| | - Sara Wilcox
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Bo Cai
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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Maxwell JR, DiDomenico J, Roberts MH, Marquez LE, Rai R, Weinberg J, Jacobson SW, Stephen J, Bakhireva LN. Impact of low-level prenatal alcohol exposure and maternal stress on autonomic regulation. Pediatr Res 2024; 95:350-358. [PMID: 37674025 PMCID: PMC11089775 DOI: 10.1038/s41390-023-02799-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/07/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) impacts the neurodevelopment of the fetus, including the infant's ability to self-regulate. Heart rate variability (HRV), that is, the beat-to-beat variability in heart rate, is a non-invasive measurement that can indicate autonomic nervous system (ANS) function/dysfunction. METHODS The study consisted of a subset of our ENRICH-2 cohort: 80 participants (32 PAE and 48 Controls) who had completed three visits during pregnancy. The participants completed a comprehensive assessment of PAE and other substances throughout pregnancy and assessments for stress, anxiety, and depression in the third trimester. At 24 h of age, infant HRV was assessed in the hospital during the clinically indicated heel lance; 3- to 5-min HRV epochs were obtained during baseline, heel lancing, and recovery episodes. RESULTS Parameters of HRV differed in infants with PAE compared to Controls during the recovery phase of the heel lance (respiratory sinus arrhythmia (RSA) and high-frequency (HF), p < 0.05). Increased maternal stress was also strongly associated with abnormalities in RSA, HF, and low-frequency / high-frequency (LF/HF, p's < 0.05). CONCLUSIONS Alterations in ANS regulation associated with PAE and maternal stress may reflect abnormal development of the hypothalamic-pituitary-adrenal axis and have long term implications for infant responsiveness and self-regulation. IMPACT Previous studies have focused on effects of moderate to heavy prenatal alcohol exposure (PAE) on autonomic dysregulation, but little is known about the effects of lower levels of PAE on infant self-regulation and heart rate variability (HRV). Prenatal stress is another risk factor for autonomic dysregulation. Mild PAE impacts infant self-regulation, which can be assessed using HRV. However, the effect of prenatal stress is stronger than that of mild PAE or other mental health variables on autonomic dysregulation.
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Affiliation(s)
- Jessie R Maxwell
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, Mexico.
- Department of Neurosciences, University of New Mexico, Albuquerque, NM, Mexico.
| | - Jared DiDomenico
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Melissa H Roberts
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Lidia Enriquez Marquez
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Rajani Rai
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Joanne Weinberg
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Sandra W Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Julia Stephen
- The Mind Research Network, a Division of Lovelace Biomedical Research Institute, University of New Mexico, Albuquerque, NM, Mexico
| | - Ludmila N Bakhireva
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
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Li R, Karukivi M, Lindblom J, Korja R, Karlsson L, Karlsson H, Nolvi S. Trajectories of COVID-19 pandemic-related depressive symptoms and potential predictors: the FinnBrain Birth Cohort Study. Soc Psychiatry Psychiatr Epidemiol 2024; 59:151-163. [PMID: 37668674 PMCID: PMC10799828 DOI: 10.1007/s00127-023-02559-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/21/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE In the context of the COVID-19 pandemic, mental health problems have been reported, and parents of young children may be more vulnerable to psychological distress due to increased caregiving responsibilities. However, research on the heterogeneity of the longitudinal course of psychological symptoms during the pandemic and the predispositions linked with these courses is still scarce. This study aimed to identify differential trajectories of depressive symptoms among the parents of young children and investigate the role of temperament traits, alexithymia, and coping styles in the heterogeneity of the symptom trajectories. METHODS The sample consists of 844 parents from the FinnBrain Birth Cohort Study. Latent growth mixture modeling was utilized to identify trajectories of depressive symptoms from pre-pandemic between 2014 and 2019 (T0, the closest available measurement was used) to May/June 2020 (T1) and December 2020 (T2) during the pandemic. Multinomial logistic regression was used to examine temperament, alexithymia, and coping as predictors of symptom trajectories, controlling for various background factors. RESULTS Four trajectories of depressive symptoms were identified. Most parents experienced low and stable depressive symptoms. Negative affect, effortful control, alexithymia, emotion-diverting coping (self-distraction and venting), and avoidant coping (denial and behavioral disengagement) were predictors for subclinical stable depressive symptoms. Constructive coping (positive reframing, acceptance, and humor) protected the cohort parents from increasing or moderately high depressive symptoms. CONCLUSIONS The findings have implications for identifying vulnerable individuals with specific traits and strengthening of constructive coping strategies as possible foci in interventions for depression during global crises.
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Affiliation(s)
- Ru Li
- Department of Psychiatry, University of Turku and Turku University Hospital, Medisiina A, Kiinamyllynkatu 8-10, Turku, Finland.
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, University of Turku, Turku, Finland.
| | - Max Karukivi
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Adolescent Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Jallu Lindblom
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, University of Turku, Turku, Finland
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Riikka Korja
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
| | - Linnea Karlsson
- Department of Psychiatry, University of Turku and Turku University Hospital, Medisiina A, Kiinamyllynkatu 8-10, Turku, Finland
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Department of Pediatrics and Adolescent Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Hasse Karlsson
- Department of Psychiatry, University of Turku and Turku University Hospital, Medisiina A, Kiinamyllynkatu 8-10, Turku, Finland
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Saara Nolvi
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, University of Turku, Turku, Finland
- Turku Institute for Advanced Studies, University of Turku, Turku, Finland
- Department of Medical Psychology, Charité Universitätsmedizin, Berlin, Germany
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
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Xu Y, Zheng P, Feng W, Chen L, Sun S, Liu J, Tang W, Bao C, Xu L, Xu D, Zhao K. Patterns of attentional bias in antenatal depression: an eye-tracking study. Front Behav Neurosci 2023; 17:1288616. [PMID: 38192488 PMCID: PMC10773570 DOI: 10.3389/fnbeh.2023.1288616] [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: 09/04/2023] [Accepted: 11/07/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction One of the most common mental disorders in the perinatal period is depression, which is associated with impaired emotional functioning due to alterations in different cognitive aspects including thought and facial emotion recognition. These functional impairment may affect emerging maternal sensitivity and have lasting consequences for the dyadic relationship. The current study aimed to investigate the impact of depressive symptoms on the attention bias of infant stimuli during pregnancy. Methods Eighty-six pregnant women completed the Edinburgh Postnatal Depression Scale and an eye-tracking task comprising infant-related emotion images. All participants showed biased attention to infant-related images. Results First, compared to healthy pregnant women, pregnant women with depression symptoms initially directed their attention to infant-related stimuli more quickly (F (1, 84) = 6.175, p = 0.015, η2 = 0.068). Second, the two groups of pregnant women paid attention to the positive infant stimuli faster than the neutral infant stimuli, and the first fixation latency bias score was significantly smaller than that of the infant-related negative stimulus (p = 0.007). Third, compared with the neutral stimulus, the non-depression group showed a longer first gaze duration to the negative stimulus of infants (p = 0.019), while the depressive symptoms group did not show this difference. Conclusion We speculate that structural and functional changes in affective motivation and cognitive-attention brain areas may induce these attentional bias patterns. These results provide suggestions for the implementation of clinical intervention programs to correct the attention bias of antenatal depressed women.
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Affiliation(s)
- Yao Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Peiwen Zheng
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Wenqian Feng
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, Chengdu, China
| | - Lipeng Chen
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Shiyu Sun
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Jie Liu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Weina Tang
- Shaoxing 7th People’s Hospital, Shaoxing, China
| | - Ciqing Bao
- Wenzhou Seventh People’s Hospital, Wenzhou, China
| | - Ling Xu
- Wenzhou Seventh People’s Hospital, Wenzhou, China
| | - Dongwu Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Ke Zhao
- Lishui Second People’s Hospital Affiliated to Wenzhou Medical University, Lishui, China
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, China
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Yamada K, Endo M, Ohashi K. Depression and diet-related distress among Japanese women with gestational diabetes mellitus. Nurs Health Sci 2023; 25:609-618. [PMID: 37772678 DOI: 10.1111/nhs.13054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 08/26/2023] [Accepted: 09/17/2023] [Indexed: 09/30/2023]
Abstract
Although the association between gestational diabetes mellitus (GDM) and maternal postpartum depression has been reported, the association between these two factors during pregnancy has not been sufficiently examined. We compared pregnant women with and without GDM to clarify the association and examined factors related to depression in pregnant women with GDM. Questionnaires were administered longitudinally to pregnant Japanese women in the third trimester and at 2 and 4 weeks postpartum. One hundred and five and 108 pregnant women with and without GDM, respectively, were included in the study. Of the 105 women with GDM, 20 (19.0%) reported being depressed during pregnancy, which was significantly higher than that among those without GDM (9.3%). Binomial logistic regression analysis revealed that depression was significantly positively associated with diet-related distress and negatively associated with social support among women with GDM. Diet-related distress and social support are important factors in managing depression in pregnant women with GDM.
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Affiliation(s)
- Kanako Yamada
- Graduate School of Nuring, Osaka Metropolitan University, Osaka, Japan
- Division of Health Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masayuki Endo
- Division of Health Science, Graduate School of Medicine, Osaka University, Osaka, Japan
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Pazzagli C, Buratta L, Coletti E, Mazzeschi C. Mother-to-infant bonding mediates the effects of depressive and anxious postpartum symptoms on parenting stress. J Psychosom Obstet Gynaecol 2023; 44:2264487. [PMID: 37837341 DOI: 10.1080/0167482x.2023.2264487] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/24/2023] [Indexed: 10/16/2023] Open
Abstract
A number of studies have suggested close associations between maternal postpartum mental health (depressive and anxious symptoms), mother-infant bonding, and parenting stress. However, the relationship between maternal bonding and parenting stresshas hardly been explored in published literature. This cross-sectional study explored whether maternal bonding could mediate the effect of postpartum maternal mental health on parenting stress. This study assessed maternal bonding (MPAS), depressive and anxious symptoms (EPDS; STAI), and parenting stress (PSI) at 3 months postpartum in a community sample of 105 women (M (SD) = 32.60 (4.18) years old). Spearman's correlation analyses showed moderate to high correlations between these factors. The three mediation models run showed that mother's MPAS partially mitigates the effects of EPDS (b = 0.71; SE = 0.217; 95% CI = 0.290/1.136) and STAI State (b = 0.39; SE = 0.113; 95% CI = 0.178/0.625) on PSI, and totally mediated the relationship between STAI Trait and PSI (b = 0.59; SE = 0.155; 95% CI = 0.303/0.912). Maternal bonding resulted to be a relevant factor in the association between maternal mental health and parenting stress. This highlights the importance of interventions focusing on mother-infant relationship to reduce parenting stress and prevent developmental difficulties in children.
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Affiliation(s)
- Chiara Pazzagli
- Department of Dynamic and Clinical Psychology, and Health Studies - Faculty of Medicine and Psychology, Sapienza University of Rome, Roma, Italy
| | - Livia Buratta
- Department of Philosophy, Social Sciences and Education, University of Perugia, Perugia, Italy
| | - Elena Coletti
- Department of Dynamic and Clinical Psychology, and Health Studies - Faculty of Medicine and Psychology, Sapienza University of Rome, Roma, Italy
| | - Claudia Mazzeschi
- Department of Philosophy, Social Sciences and Education, University of Perugia, Perugia, Italy
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Hong LF, Chua TE, Ch'ng YC, Chui K, Chen HY. The Postnatal Depression Intervention Program "PNDIP": A 10-year review. Asian J Psychiatr 2023; 90:103807. [PMID: 37871363 DOI: 10.1016/j.ajp.2023.103807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023]
Abstract
The Postnatal Depression Intervention Program is a screening program looking at postnatal depression in newly delivered mothers at KK Hospital in Singapore. The primary objective of the paper is to evaluate the outcomes based on changes in scores from baseline to end of intervention with reference to depressive symptoms, using the Edinburgh Postnatal Depression Scale and overall functioning based on the Global Assessment of Functioning. These changes were found to be statistically significant. We also described the demographics of the 10-year cohort with majority being married, Chinese, aged between 25 and 34 years old and received at least tertiary education.
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Affiliation(s)
- Lin Feng Hong
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore.
| | - Tze-Ern Chua
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore
| | - Ying Chia Ch'ng
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore
| | | | - Helen Yu Chen
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore
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Atuhaire C, Brennaman L, Nambozi G, Taseera K, Atukunda EC, Ngonzi J, Atwine D, Matthews LT, Rukundo GZ. Validating the Edinburgh Postnatal Depression Scale Against the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition for Use in Uganda. Int J Womens Health 2023; 15:1821-1832. [PMID: 38020941 PMCID: PMC10676086 DOI: 10.2147/ijwh.s427752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background The Edinburgh Postnatal Depression Scale (EPDS) is a widely acknowledged screening tool for postpartum depression (PPD) globally, but its validation in Uganda has been lacking. This study aimed to assess the EPDS's accuracy as a PPD screening tool in Uganda compared to the Mini-International Neuropsychiatric Interview (MINI 7.0.2) based on the DSM-5. Methods This was a descriptive cross-sectional study conducted at a referral hospital and two peri-urban primary care postpartum clinics in rural southwestern Uganda. We enrolled 287 mothers aged 18 to 49 at their six-week postpartum visit. The EPDS was used for initial screening, and the MINI 7.0.2 was employed for clinical diagnosis. The study used the Runyankore-Rukiga language version of the EPDS and collected data from November 11, 2019, to June 10, 2020, with the MINI 7.0.2 as the reference standard. Results The overall PPD prevalence was 29.5%, as opposed to 26.5% with EPDS and MINI 7.0.2 DSM-5 criteria (p = 0.239). The EPDS demonstrated a sensitivity of 86.8%, specificity of 92.1%, positive predictive value of 80.5%, and negative predictive value of 94.9%. A cutoff score of ≥10 was found to be the most effective acceptable point after drawing the AUC of ROC and determining the most appropriate point using Youden's index. The area under the ROC curve, indicating the scale's overall performance against MINI 7.0.2, was 0.89 for Bwizibwera HCIV, 0.97 for Kinoni HCIV, and 0.84 for MRRH. In conclusion, the EPDS can effectively screen for postpartum depression in southwestern Uganda using a cutoff score of ≥10. It exhibits strong diagnostic performance in correctly identifying PPD in postpartum mothers.
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Affiliation(s)
- Catherine Atuhaire
- Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Laura Brennaman
- Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Grace Nambozi
- Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Kabanda Taseera
- Department of Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Esther C Atukunda
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joseph Ngonzi
- Department of Obstetrics & Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Lynn T Matthews
- Division of Infectious Diseases and Center for Global Health Massachusetts General Hospital, Boston, MA, USA
- Division of Infectious Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
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Sobol M, Błachnio A, Meisner M, Wdowiak A, Sobol MK. The relationship of couples' time perspective to pregnant women's depression symptoms and stress: Preliminary results. J Psychosom Res 2023; 174:111495. [PMID: 37717426 DOI: 10.1016/j.jpsychores.2023.111495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 09/02/2023] [Accepted: 09/10/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE The aim of the study was to examine the relationship of a couple's time perspective to a woman's depression symptoms and stress. METHOD The participants were 48 pregnant women and 46 male partners of these women. The measurements have been taken during the first and third trimester. Women were examined by gynecologists during gynecological visits. During these visits measurements of gynecological pregnancy evaluation were administered. Then women completed online questionnaires: the Zimbardo Time Perspective Inventory Past Negative scale, the Dark Future Scale, the Edinburgh Postpartum Depression Scale and the Perceived Stress Scale at home. Men completed online questionnaires: the Zimbardo Time Perspective Inventory Past Negative scale, and the Dark Future Scale at home. RESULTS The results showed that women's past negative perspective in the first trimester was related to depression symptoms and stress in the first trimester. In the third trimester, women's future negative perspective was related to depression symptoms. Men's future negative perspective in the first trimester was related to women's stress in the first trimester. Moreover, the results suggest that the level of the woman's future negative perspective significantly increases during pregnancy. CONCLUSIONS Attitudes towards time of both the pregnant woman and her partner are related to the emotional state of the woman during pregnancy.
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Affiliation(s)
- Małgorzata Sobol
- Department of Psychology, University of Warsaw, ul. Stawki 5/7, 00-183 Warsaw, Poland.
| | - Agata Błachnio
- John Paul II Catholic University of Lublin, al. Raclawickie 14, 20-950 Lublin, Poland
| | - Michał Meisner
- Department of Psychology, University of Warsaw, ul. Stawki 5/7, 00-183 Warsaw, Poland
| | - Artur Wdowiak
- Medical University of Lublin, Al. Racławickie 1, 20-059 Lublin, Poland
| | - Marek K Sobol
- Hospital Center Châlons-En-Champagne, 51 Rue du Commandant Derrien, 51000 Châlons-En-Champagne, France
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Baumgartel K, Caplan E, Glover C, Louis J, Schreiber J. A Feasibility Study to Assess Sleep and Subsequent Breast Milk Volume Among Mothers With Hospitalized Preterm Infants. J Perinat Neonatal Nurs 2023; 37:295-302. [PMID: 37878514 PMCID: PMC10605565 DOI: 10.1097/jpn.0000000000000657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND Sleep is essential for optimal health, and disturbed postpartum sleep is associated with compromised infant attachment. The postpartum experience of mothers with preterm infants is unlike the biological norm, as they are separated from their infants and often express breast milk. PURPOSE The purpose of this study was to examine the feasibility of conducting a clinical research study among women with hospitalized preterm infants. We also explored for associations between maternal sleep patterns and sleep-related psychological states and subsequent breast milk volume. METHODS Participants were recruited from Magee-Womens Hospital, located in Pittsburgh, Pennsylvania New mothers completed daily sleep and pumping logs and scales to measure stress, trauma, depression, fatigue, and sleep quality. RESULTS A total of 78 women were screened, 18 women consented, and a total of 8 participants completed the study. Screening from the postpartum unit increased recruitment. The participants experience worsening sleep quality over time, moderate stress, and fatigue. Stress, postnatal depression, and fatigue are negatively associated with milk volume. IMPLICATIONS FOR PRACTICE AND RESEARCH Postpartum recruitment with frequent follow-ups improved recruitment and retention. We present a preliminary association between maternal stress, fatigue, and depression, and subsequent breast milk volume. Sleep-related psychological states may negatively influence milk volume.
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Affiliation(s)
- Kelley Baumgartel
- University of South Florida College of Nursing, Tampa (Dr Baumgartel); University of Pittsburgh School of Nursing, Health Promotion and Development, Pittsburgh, Pennsylvania (Ms Caplan); University of Pittsburgh, Pittsburgh, Pennsylvania (Ms Glover); College of Medicine Obstetrics and Gynecology, COPH Dean's Office, University of South Florida, Tampa (Dr Louis); and Duquesne University School of Nursing, Pittsburgh, Pittsburgh (Dr Schreiber)
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Foss S, Petty CR, Howell C, Mendonca J, Bosse A, Waber DP, Wright RJ, Enlow MB. Associations among maternal lifetime trauma, psychological symptoms in pregnancy, and infant stress reactivity and regulation. Dev Psychopathol 2023; 35:1714-1731. [PMID: 35678173 PMCID: PMC9732151 DOI: 10.1017/s0954579422000402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Maternal trauma has intergenerational implications, including worse birth outcomes, altered brain morphology, and poorer mental health. Research investigating intergenerational effects of maternal trauma on infant stress reactivity and regulation is limited. Maternal mental health during pregnancy may be a contributor: psychopathology is a sequela of trauma exposure and predictor of altered self-regulatory capacity in offspring of affected mothers. We assessed associations among maternal lifetime trauma and infant stress responsivity, mediated by psychological symptoms in pregnancy. Mothers reported lifetime trauma history and anxiety, depressive, and posttraumatic stress symptoms during pregnancy. At infant age 6 months, stress reactivity and regulation were assessed via maternal behavior ratings (Infant Behavior Questionnaire-Revised, IBQ-R) and behavioral (negative mood) and physiological (respiratory sinus arrhythmia, RSA) markers during a laboratory stressor (Still-Face Paradigm). Maternal trauma was directly associated with lower infant physiological regulation and indirectly associated with lower levels of both infant behavioral and physiological regulation via higher maternal anxiety during pregnancy. Maternal trauma was also indirectly associated with higher infant reactivity via higher maternal anxiety during pregnancy. Post hoc analyses indicated differential contributions of maternal prenatal versus postnatal anxiety to infant outcomes. Findings highlight potential contributory mechanisms toward maladaptive child stress response, which has been associated with poor behavioral, cognitive, and academic outcomes.
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Affiliation(s)
- Sophie Foss
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Carter R. Petty
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA, USA
| | - Caroline Howell
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
| | - Juliana Mendonca
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
| | - Abigail Bosse
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
| | - Deborah P. Waber
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Rosalind J. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Kravis Children’s Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michelle Bosquet Enlow
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Huang R, Han H, Ding L, Zhou Y, Hou Y, Yao X, Cai C, Li X, Song J, Zhang S, Jiang H. Using the theory of planned behavior model to predict factors influencing breastfeeding behavior among preterm mothers at week 6 postpartum: the mediating effect of breastfeeding intention. Front Psychol 2023; 14:1228769. [PMID: 37744580 PMCID: PMC10514476 DOI: 10.3389/fpsyg.2023.1228769] [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: 06/29/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Background Exclusive breastfeeding (EBF) in the first 6 weeks postpartum is key to continued breastfeeding. This study aimed to explore the role of EBF-related predictors (particularly breastfeeding intention) in breastfeeding behavior among preterm mothers at week 6 postpartum based on the theory of planned behavior (TPB). Methods A total of 352 mothers of preterm infants were recruited, 340 of whom participated in this study. Prior to discharge, participants completed the Chinese versions of the modified Breastfeeding Attrition Predictive Tool, the Breastfeeding Knowledge Questionnaire (BKQ), the Infant Feeding Intention, and the Edinburgh Postnatal Depression Scale. Responses to the items of the Breastfeeding Behavioral Questionnaire (BBQ) were also collected by telephone at week 6 postpartum. The final analyses included 321 participants who completed the full two-wave data collection. Results The fitness indices of the modified TPB model were acceptable. Breastfeeding knowledge and EBF before discharge positively impacted breastfeeding intention, whereas depression had a negative impact. Before discharge, breastfeeding intention fully mediated the impacts of breastfeeding attitude, social and professional support, knowledge, depression, and EBF on breastfeeding behavior and partially mediated the influence of perceived breastfeeding control on breastfeeding behavior. Conclusion These findings indicate that TPB accurately predicts breastfeeding behavior among preterm mothers at week 6 postpartum, and breastfeeding intention is key to the above-mentioned EBF-related factors and breastfeeding behavior. The findings underline the need for further longitudinal studies and corresponding interventions for preterm mothers with a high risk of EBF attrition.
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Affiliation(s)
- Rong Huang
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hui Han
- School of Medicine, Tongji University, Shanghai, China
| | - Lijing Ding
- School of Medicine, Tongji University, Shanghai, China
| | - Yi Zhou
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yanwen Hou
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiao Yao
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chenting Cai
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaohan Li
- School of Medicine, Tongji University, Shanghai, China
| | - Jianqi Song
- School of Medicine, Tongji University, Shanghai, China
| | - Shuying Zhang
- School of Medicine, Tongji University, Shanghai, China
| | - Hui Jiang
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
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Wu CH, Gau ML, Cheng SF, Chen TL, Wu CJ. Excessive gestational weight gain and emotional eating are positively associated with postpartum depressive symptoms among taiwanese women. BMC Womens Health 2023; 23:464. [PMID: 37658388 PMCID: PMC10474696 DOI: 10.1186/s12905-023-02625-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Excessive gestational weight gain and emotional eating may be associated with postpartum depression symptoms. This study was designed to identify how gestational weight gain and eating behaviors are related to postpartum depression (PPD) symptoms among women in Taiwan. METHODS A cross-sectional study was conducted from March 2022 to October 2022 with 318 postpartum women recruited in Taipei, Taiwan. Gestational weight gain (GWG) for the total pregnancy period was recorded as inadequate, adequate, or excessive, based on the 2009 Institute of Medicine recommendations (IOM), accounting for pre-pregnancy body mass index category. Eating behavior at one month postpartum was measured on a 16-item 5-point Likert scale with three subscales: uncontrolled, restrained, and emotional. Maternal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale with a cutoff score of 13. RESULTS The prevalence of postpartum depression symptoms (Edinburgh Postnatal Depression Scale ≥ 13) was 23.9% at one month postpartum. Logistic regression analysis revealed that excessive gestational weight gain and emotional eating were positively associated with postpartum depression symptoms at that time. CONCLUSION Evidence presented here suggests that emotional eating and excessive GWG are associated with PPD symptoms in a Taiwanese population. In addition, it should be a public health priority to ensure a particular focus on mental health during the postpartum period. Healthcare providers should discourage pregnant women from unhealthy eating habits by targeting appropriate GWG and focusing on demand eating to reduce PPD in the postpartum period.
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Affiliation(s)
- Chia-Hsun Wu
- Obstetrician and gynecologist, Department of Obstetrics and Gynecology, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Meei-Ling Gau
- Department of Nurse-Midwifery and Women's Health, National Taipei University of Nursing and Health Sciences, 365, Ming-Te Rd, Peitou District, 11219, Taipei, Taiwan
| | - Su-Fen Cheng
- Department of Allied Health Education and Digital Learning, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Tzu-Ling Chen
- Department of Nurse-Midwifery and Women's Health, National Taipei University of Nursing and Health Sciences, 365, Ming-Te Rd, Peitou District, 11219, Taipei, Taiwan.
| | - Chih-Jung Wu
- School of Nursing, China Medical University, Taichung, Taiwan
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Raffa BJ, Swartz JJ, Ranapurwala SI, Zhao C, Cholera R. Immigration Policy and the Health of Latina Mothers and Their Infants. J Immigr Minor Health 2023; 25:775-789. [PMID: 37020058 PMCID: PMC10330379 DOI: 10.1007/s10903-023-01476-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/07/2023]
Abstract
Restrictive immigration policies may adversely affect the health of Latina mothers and their infants. We hypothesized that undocumented Latina mothers and their US born children would have worse birth outcomes and healthcare utilization following the November 2016 election. We used a controlled interrupted time series to estimate the impact of the 2016 presidential election on low birth weight (LBW), preterm birth, maternal depression, well child visit attendance, cancelled visits, and emergency department (ED) visits among infants born to Latina mothers on emergency Medicaid, a proxy for undocumented immigration status. There was a 5.8% (95% CI: -0.99%, 12.5%) increase in LBW and 4.6% (95% CI: -1.8%, 10.9%) increase in preterm births immediately after the 2016 election compared to controls. While these findings were not statistically significant at p < 0.05, the majority of our data suggest worsened birth outcomes among undocumented Latina mothers after the election, consistent with larger prior studies. There was no difference in well child or ED visits. While restrictive policies may have contributed to worse birth outcomes among undocumented Latina mothers, our findings suggest that Latino families still attend infants' scheduled visits.
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Affiliation(s)
- Brittany J Raffa
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Jonas J Swartz
- Division of Women's Community and Population Health, Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Shabbar I Ranapurwala
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Congwen Zhao
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Rushina Cholera
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Margolis Center for Health Policy, Duke University, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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Brown Z, Messaoudi C, Silvia E, Bleau H, Meskill A, Flynn A, Abel-Bey AC, Ball TJ. Postpartum navigation decreases severe maternal morbidity most among Black women. Am J Obstet Gynecol 2023; 229:160.e1-160.e8. [PMID: 36610531 DOI: 10.1016/j.ajog.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023]
Abstract
BACKGROUND Postpartum care is crucial for addressing conditions associated with severe maternal morbidity and mortality. Examination of programs that affect these outcomes for women at high risk, including disparate populations, is needed. OBJECTIVE This study aimed to examine whether a postpartum navigation program decreases all-cause 30-day postpartum hospitalizations and hospitalizations because of severe maternal morbidity identified using the US Centers for Disease Control and Prevention guidelines. The effect of this program was explored across patient demographics, including race and ethnicity. STUDY DESIGN This was a retrospective cohort study that used health records of women who delivered at 3 large hospitals in the New York metropolitan area (Queens and Long Island) between April 2020 and November 2021 and who were at high risk of severe maternal morbidity. The incidence rates of 30-day postpartum all-cause hospitalization and hospitalization because of severe maternal morbidity were compared between women who were and were not enrolled in a novel postpartum transitional care management program. Navigation included standardized assessments, development of care plans, clinical management, and connection to clinical and social services that would extend beyond the postpartum period. Because the program prioritized enrolling women of the greatest risk, the risk-adjusted incidence was estimated using multivariate Poisson regression and stratified across patient demographics. RESULTS Patient health records of 5819 women were included for analysis. Of note, 5819 of 19,258 deliveries (30.2%) during the study period were identified as having a higher risk of severe maternal morbidity. This was consistent with the incidence of high-risk pregnancies for tertiary hospitals in the New York metropolitan area. The condition most identified for risk of severe maternal morbidity at the time of delivery was hypertension (3171/5819 [54.5%]). The adjusted incidence of all-cause rehospitalization was 20% lower in enrollees than in nonenrollees (incident rate ratio, 0.80; 95% confidence interval, 0.67-0.95). Rehospitalization was decreased the most among Black women (incident rate ratio, 0.57; 95% confidence interval, 0.42-0.80). The adjusted incidence of rehospitalization because of indicators of severe maternal morbidity was 56% lower in enrollees than in nonenrollees (incident rate ratio, 0.44; 95% confidence interval, 0.24-0.77). Furthermore, it decreased most among Black women (incident rate ratio, 0.23; 95% confidence interval, 0.07-0.73). CONCLUSION High-risk medical conditions at the time of delivery increased the risk of postpartum hospitalization, including hospitalizations because of severe maternal morbidity. A postpartum navigation program designed to identify and resolve clinical and social needs reduced postpartum hospitalizations and racial disparities with hospitalizations. Hospitals and healthcare systems should adopt this type of care model for women at high risk of severe maternal morbidity. Cost analyses are needed to evaluate the financial effect of postpartum navigation programs for women at high risk of severe maternal morbidity or mortality, which could influence reimbursement for these types of services. Further evidence and details of novel postpartum interventional models are needed for future studies.
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Affiliation(s)
- Zenobia Brown
- Northwell Health, Health Solutions Population Health Management, Manhasset, NY.
| | - Choukri Messaoudi
- Northwell Health, Health Solutions Population Health Management, Manhasset, NY
| | - Emily Silvia
- Northwell Health, Health Solutions Population Health Management, Manhasset, NY
| | - Hallie Bleau
- Northwell Health, Health Solutions Population Health Management, Manhasset, NY
| | - Ashley Meskill
- Northwell Health, Health Solutions Population Health Management, Manhasset, NY
| | - Anne Flynn
- Northwell Health, Health Solutions Population Health Management, Manhasset, NY
| | - Amparo C Abel-Bey
- Northwell Health, Health Solutions Population Health Management, Manhasset, NY
| | - Trever J Ball
- Northwell Health, Health Solutions Population Health Management, Manhasset, NY
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Ruiz MT, Rodrigues EDC, da Silva KEPO, de Resende CV, Cavalcanti MC, Dos Santos LM, Wernet M, Gomes ALM, Christoffel MM, Raponi MBG, da Silva JA, de Oliveira JF, Contim D, Linares AM. Effectiveness of individualized counseling on the duration of exclusive breastfeeding: study protocol for a multicenter, randomized, parallel, and open clinical trial. Trials 2023; 24:455. [PMID: 37454111 DOI: 10.1186/s13063-023-07490-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Despite the benefits of breastfeeding, early weaning is a reality, so less than 50% of children worldwide and in Brazil are on exclusive breastfeeding in the sixth month of life. A strategy to counteract this scenario is breastfeeding counseling. This study aims to verify the effectiveness of individualized counseling by nurses trained in breastfeeding counseling, on the duration of exclusive breastfeeding, compared to standard care. METHODS Multicenter, randomized, parallel, and open clinical trial, with primiparous women aged over 18 years, hospitalized in rooming-in wards at participating centers and hemodynamically stable, aware, and oriented, who had a single-fetus pregnancy and gave birth, regardless of the type of delivery, with live child, gestational age of 37 to 42 weeks and birth weight greater than 2500 g. The women will be initially approached in rooming-in wards and, upon consent to participate in the study, will be allocated through randomization by blocks composed of eight participants in two groups: intervention and control. The randomization lists will be organized by a central without involvement with the study, which will manage the allocation groups and be prepared in the Randon® program. Women allocated to the intervention group will receive breastfeeding counseling by trained nurses, and those in the control group will receive standard care at the center participating in the study. DISCUSSION The results can contribute to breastfeeding by evidencing possible exclusivity and duration of the counseling trained nurses provide. TRIAL REGISTRATION REBEC RBR-4w9v5rq (UTN: U1111-1284-3559) ( https://ensaiosclinicos.gov.br/rg/RBR-4w9v5rq ). Posted on March 20, 2023.
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Affiliation(s)
- Mariana Torreglosa Ruiz
- Didactic-Scientific Department of Nursing in Hospital Care, Institute of Health Sciences, Federal University of Triangle Mineiro, Av. Getúlio Guaritá, 107, Uberaba, Minas Gerais, Minas Gerais, 38025-440, Uberaba, Brazil.
| | - Elisa da Conceição Rodrigues
- Graduate/Posgraduate Program in Nursing, Anna Nery School of Nursing, Rua Afonso Cavalcanti, Cidade Nova 20211110, 275, Rio de Janeiro, Brazil
| | | | - Cynthya Viana de Resende
- Stricto Sensu Graduate Program in Health Care, Federal University of Triangle Mineiro, Av. Getúlio Guaritá, Av. Getúlio Guaritá, 107, Minas Gerais, 38025-440, Uberaba, Brazil
| | - Michele Curcino Cavalcanti
- Stricto sensu Graduate Program in Nursing, Anna Nery School of Nursing, Rua Afonso Cavalcanti, 275, Cidade Nova, 20211110, Rio de Janeiro, Brazil
| | - Luciano Marques Dos Santos
- Health Department, Collegiate of the Nursing Course, State University of Feira de Santana, Avenida Transnordestina, SN, 44036-900, Feira de Santana, Bahia, Brazil
| | - Monika Wernet
- Pos graduate Program in Nursing Federal, University of Sāo Carlos, Rodovia Washington Luis, km 235, 13565905, São Paulo, Brazil
| | - Ana Letícia Monteiro Gomes
- Graduate in Nursing, Anna Nery School of Nursing, Rua Afonso Cavalcanti, 275, 20211110, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marialda Moreira Christoffel
- Institute of Nursing, Granja Dos Cavaleiros, UFRJ Multidisciplinary Center - Macaé, Federal University of Rio de Janeiro, Av. Aluizio da Silva Gomes, 50, Macaé, 27930560, Rio de Janeiro, Brazil
| | - Maria Beatriz Guimarães Raponi
- School of Medicine, Nursing Course, Federal University of Uberlândia, Avenida Pará, Bloco 2U, 1720, Umuarama, Minas Gerais, 38400-902, Uberlândia, Brazil
| | - Jéssica Aparecida da Silva
- Multiprofessional Integrated Residency Program in Health - Integrated and Humanized Health Care, Federal University of Triangle Mineiro, Av. Getúlio Guaritá, Minas Gerais CEP, Av. Aluizio da Silva Gomes, 50, Macaé, 38025-440, Rio de Janeiro, Brazil
| | - Jacqueline Faria de Oliveira
- Clinic Hospital of Federal University of Triangle Mineiro, Av. Getúlio Guaritá, Minas Gerais CEP, Uberaba, 13038025-440, Brazil
| | - Divanice Contim
- Didactic-Scientific Department of Nursing in Hospital Care, Institute of Health Sciences, Federal University of Triangle Mineiro, Av. Getúlio Guaritá, 107, 38025-440, Uberaba, Brazil
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Kaiyo-Utete M, Langhaug L, Chingono A, Dambi JM, Magwali T, Henderson C, Chirenje ZM. Antenatal depression: Associations with birth and neonatal outcomes among women attending maternity care in Harare, Zimbabwe. PLoS One 2023; 18:e0270873. [PMID: 37418441 PMCID: PMC10328234 DOI: 10.1371/journal.pone.0270873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/21/2022] [Indexed: 07/09/2023] Open
Abstract
INTRODUCTION Antenatal depression is highly prevalent and is associated with negative birth and neonatal outcomes. However, the mechanisms and causality behind these associations remain poorly understood as they are varied. Given the variability in whether associations are present, there is need to have context-specific data to understand the complex factors that go into these associations. This study aimed to assess the associations between antenatal depression and birth and neonatal outcomes among women attending maternity care in Harare, Zimbabwe. METHODS We followed 354 pregnant women in second or third trimester, attending antenatal care services in two randomly selected clinics in Harare, Zimbabwe. Antenatal depression was assessed using the Structured Clinical Interview for DSM-IV. Birth outcomes included birth weight, gestational age at delivery, mode of delivery, Apgar score, and initiation of breastfeeding within one-hour postdelivery. Neonatal outcomes at six weeks postdelivery included infant's weight, height, illness, feeding methods and maternal postnatal depressive symptoms. The association between antenatal depression and categorical and continuous outcomes were assessed by logistic regression and point-biserial correlation coefficient, respectively. Multivariable logistic regression determined the confounding effects on statistically significant outcomes. RESULTS Prevalence of antenatal depression was 23.7%. It was associated with low birthweight [AOR = 2.30 (95% CI: 1.08-4.90)], exclusive breastfeeding [AOR = 0.42 (95%CI: 0.25-0.73)] and postnatal depressive symptoms [AOR = 4.99 (95%CI: 2.81-8.85)], but not with any other birth or neonatal outcomes measured. CONCLUSIONS The prevalence of antenatal depression in this sample is high with significant associations demonstrated for birth weight, maternal postnatal depressive symptoms and infant feeding methods Effective management of antenatal depression is thus crucial to the promotion of maternal and child health.
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Affiliation(s)
- Malinda Kaiyo-Utete
- Department of Primary Health Care Sciences, Mental Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- African Mental Health Research Initiative (AMARI), Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Lisa Langhaug
- African Mental Health Research Initiative (AMARI), Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Alfred Chingono
- Department of Primary Health Care Sciences, Mental Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Jermaine M. Dambi
- African Mental Health Research Initiative (AMARI), Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- Department of Primary Health Care Sciences, Rehabilitation Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- The Friendship Bench, Harare, Zimbabwe
| | - Thulani Magwali
- Department of Primary Health Care Sciences, Obstetrics and Gynaecology Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Claire Henderson
- Department of Health Services and Population Research, King’s College London Institute of Psychiatry, Psychology and Neurosciences, London, United Kingdom
| | - Z. Mike Chirenje
- Department of Primary Health Care Sciences, Obstetrics and Gynaecology Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- Faculty of Medicine and Health Sciences, Clinical Trials Research Centre, University of Zimbabwe, Harare, Zimbabwe
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